Veterans Benefits Blog

In late May 2010, VA Secretary Eric Shinseki prepared a letter to the leaders of the House and Senate requesting that his draft legislation entitled “Veterans Benefit Programs Improvement Act of 2010” be considered and enacted. The purpose of the draft bill is to improve (1) VA’s compensation and pension programs, (2) the timeliness and efficiency of VA’s adjudication of claims and appeals, (3) VA’s loan guaranty system, (4) vocational rehabilitation and education benefits, and (5) Veterans Group Life Insurance participants. Details of the particulars with respect to the suggested changes and reasons for them can be viewed at: http://www.vawatchdog.org/10/nf10/nfmay10/may10files/SecyLegislation.pdf
While it is clear that many of the proposed changes appear good for veterans, there are several items that have surfaced that may negatively impact the legal representation of veterans.
Under Title II, Section 206, which concerns decisions of the Board of Veterans’ Appeals, the legal standard of what the Board must include in its decisions may change. VA is concerned that more than half of the claims appealed to the Veterans Court result in a remand back to the Board due to an inadequate statement of reasons or bases. The comments to the proposed change note, among others, that while some remands are necessary, many remands based on reasons or bases do not benefit the claimant. Therefore, changing the statutory language from reasons or bases to “a plausible statement of the reasons for the Board’s ultimate findings of fact and conclusions of law” would reduce the number of remands.
Under Title II, Section 207, which addresses the definition of prevailing party status for purposes of entitlement to Equal Access to Justice Act, i.e., reimbursement of attorney fees, the proposed language is alarming. If the language is adopted, attorneys who represent veterans before the United States Court of Appeals for Veterans Claims would only be eligible for reimbursement of attorney fees if, after securing a remand or reversal at the appellate level, the veteran ultimately is awarded a monetary or other benefit at the administrative level. The language further allows the Court and the Secretary to prescribe rules that would allow the Court to retain control over all remands, and only upon a showing that the veteran was awarded benefits, could the attorney be entitled to reimbursement of fees.
If either of these proposed changes become law, it is likely to negatively impact the number of attorneys willing to represent veterans at the court level. If attorneys know that the chances of recovering attorney fees is limited and that it will be that much more difficult to secure remands, the Veterans Court will likely see many more unrepresented claimants.

David J Lowenstein FAQs, Veterans Benefits Claims, Veterans Benefits Legislation Veterans Benefits Claims, Veterans Benefits Legislation, veterans disability benefits

You may have heard that VA had proposed new rules recently to allow veterans with ischemic heart disease, Parkinson’s Disease, and B-cell Leukemia, to get service connection automatically if they were exposed to Agent Orange. These rules have now been put on hold while Congress looks at whether or not to allow them to go forward.

For many years, the law has said that when scientists discover that a disease is likely to have been caused by exposure to Agent Orange, VA must add those conditions to a list of conditions which are presumptively service-connected. This means that if you were exposed to Agent Orange (and veterans who served in country in Vietnam are all presumed to have been exposed), and you develop the disease later on, you are automatically service-connected, unless VA can show there’s another cause. This list now includes conditions like Type II diabetes, and prostate cancer. The conditions are listed at http://www.publichealth.va.gov/exposures/agentorange/diseases.asp#veterans.
You can read the regulation if you like at 38 C.F.R. § 3.309(e).

Recent findings in the scientific community have confirmed that there is a relationship between Agent Orange exposure and ischemic heart disease, Parkinson’s and B-cell Leukemia. So, as was required by the law, VA proposed to add these conditions to its list of conditions that are presumptively service-connected.

The proposed regulations were published last March, and were set to become final in May. However, the United States Senate has voted to delay implementation of the new rules for another 60 days in order to think further about whether or not the science supporting the link to Agent Orange is any good. According to some news reports, some members of the Senate are upset about the amount of money it would cost to pay benefits to veterans with these diseases, and believe that these payments would be based upon weak evidence.

So, now it’s time to wait and see what will happen. In the meantime, if you’ve filed a claim for one of these conditions hoping that the new rules would be in effect soon, you’re going to have to wait a little longer. You should keep in mind that even if these regulations are never put into place, you can still tell the VA that service connection for your condition should be granted on a direct basis. If you have evidence that you now suffer from one of these conditions, you can cite to the studies relied on by VA in proposing this change, linking these conditions to Agent Orange exposure. While this may not be enough to win your case, it should require VA to consider assisting you by asking for a medical opinion about the origin of your condition.

Daniel G Krasnegor Agent Orange, FAQs, Veterans Benefits Claims Agent Orange, veterans disability benefits

     Whether a veteran claimant is seeking to establish service connection for a disability or obtain an increase in rating, a medical assessment by a doctor or other health care provider will almost always be vital. To establish service connection, a claimant needs to show a causal relationship between his or her current disability and some event or manifestation of disease in service, which, except in very obvious cases, will have to be established by someone with medical expertise. Likewise, evaluation of the degree of impairment most often requires a doctor’s input.

   Many claims fail at VA initially because the necessary medical assessment is not obtained. Veterans seeking benefits can greatly shorten the agony of a prolonged involvement with VA by dealing with this need early on. Two challenges arise.
   One is locating a doctor willing to provide the assessment. While doctors can be engaged to provide “independent medical opinions,” this is a service that must be paid for by the veteran and is usually rather costly. By far the best option for obtaining an assessment is usually the veteran’s treating physician. Such a doctor will be familiar with the veteran’s condition and will usually want to be helpful to his or her patients. This circumstance may be complicated if the veteran receives her health care from a VA facility. There used to be a VA policy that actually encouraged VA doctors to assist veterans with supporting their claims via medical opinions. That policy was abandoned by VA. But there is no prohibition against VA doctors providing information, including expert assessment, to veterans pursuing claims; some VA doctors seem to believe, mistakenly, that there is such a prohibition.
   If a veteran receives care from a non-VA doctor, or is able to convince his VA doctor to provide help, what is needed is a statement from the doctor in writing that addresses the issue in a way that will be useful in supporting the claim. (The assurance that a written statement will suffice and no live or deposition testimony will be necessary, is often a selling point for doctors.) Again, much waste of time and stress can be avoided if the medical opinion is done right to begin with. Many statements from private doctors are of little help because the doctors do not understand the VA system and do not provide the crucial information.
   Doctors do not think like lawyers, and the claim process is a legal system. One important thing to get straight with the doctor is the VA standard of proof: many doctors, if they’ve had any acquaintance with the legal system at all, will be comfortable stating opinions only to a “reasonable degree of medical certainty.” This is commonly required in civil litigation, but it is not the basis for establishing a fact in a veteran claim. Veterans need only demonstrate that something is “as likely as not” true, so doctors need to understand that if they are comfortable saying that something is just as likely as unlikely, that is enough to support a claim.
   It is also important to have the doctor include the necessary information to make the opinion valuable. She should list or describe the medical data relied on: the records reviewed, examinations performed, and tests administered. She must then provide not only a bald conclusion such as “the arthritis is related to the injury in service,” but also a reason for the conclusion, such as: “arthritis can result from traumatic injury of the type the veteran received in service, and there are no other obvious causes in the medical history, therefore it is as likely as not that his arthritis is related to service.”
   Securing a solid medical opinion can often win a case outright and, at the very least, it can make it more difficult for VA to deny, which is sometimes the essence of the fight.

David E Boelzner FAQs, Veterans Benefits Claims medical opinions, Veterans Benefits Claims, veterans disability benefits

In a previous blog posting I discussed evidence in veterans cases, including a feature unique to this system, the rule that if evidence is approximately balanced on any given point, the veteran claimant is supposed to be given the benefit of the doubt. In actual practice this favorable rule is not applied because VA determines that the evidence is not balanced. This posting will discuss how that occurs and some hints about developing your evidence to avoid some of the most common reasons for losing claims.
How VA gets around the benefit-of-the-doubt rule
The equipoise standard in veterans cases seems like a highly favorable factor: all one has to do to win is show it’s 50-50. The rub comes in the fact that weighing evidence has a large component of subjective judgment, and by finding some items of evidence more believable than others, VA can conclude that the evidence is not balanced but is one-sided against the claim. In the example in the previous posting about a soldier fall and the immediate treatment records not including any mention of a head injury, the decision-maker might choose to believe that triage doctors are very thorough in noting any symptoms complained of, so the omission of any mention of a head injury would weigh very heavily in this decision-maker’s evaluation of the evidence. To a certain degree the decision-maker is permitted to make these evaluations and the Veterans Court will not disturb the agency’s conclusions if they are plausible.
On the other hand, VA quite often brings completely unwarranted assumptions into its weighing of evidence, such as the notion that if there are no complaints of symptoms or treatment for a condition in medical records, the veteran had no such symptoms or condition; the notion is based on the assumption that all patients always consult a doctor for every condition or complaint they have. It’s not true and it’s not in the evidence, but VA will assume it anyway. These sorts of erroneous evaluations of evidence are often the basis for appeal.
Good evidence
Presenting strong evidence to support a claim is vital to its success. The best way to accomplish this is, first, to know the key facts necessary to prove a claim, what lawyers call “elements.” The three elements of a service-connection claim are (1) an incident in service, i.e. an injury or first manifestation of a medical condition, (2) a current recognized disability, and (3) a causal relation between (1) and (2), i.e. the disability is the same condition or related to the incident in service in some way.
VA is required to send notice to all claimants of what must be proven; it often obscures this information in a blizzard of legal provisions or misleading statements about the duty to assist, but somewhere in the notice letter sent after the claim is filed will usually be a listing of the elements. Ask yourself if you have submitted or can obtain convincing information on each of those elements. (This inquiry can also serve to prompt the threshold question central to any claim: is there a provable entitlement to the benefit sought? VA does not award benefits based on sympathy or veteran hardship; it does not care legally whether you are in financial straits. It can only award based on evidence.)
Especially bear in mind that, whether your claim is for service connection or for increase of rating, it requires medical expert evidence to establish one of the key facts: you must show causal relation with an incident in service for a service connection claim, and you must show degree of severity of the condition in an increased rating claim. If you don’t have such evidence, you need to get it, either through treating physicians or perhaps by pressing VA to get a medical opinion. Having evidence that supports each of the necessary elements is the most important factor in developing a successful claim.
What is good evidence? Anything pertinent to an issue of the claim, that is, one of the crucial facts that must be proven, is relevant evidence and must be considered, but certain qualities affect the weight given to evidence. A few hints:
Direct personal knowledge. Hearsay (something somebody else told you), which is a concern in other types of legal cases, is not strictly taboo in veterans cases, but evidence is unquestionably stronger if it comes from someone with direct personal knowledge of the fact in question. A veteran can, for example, say that he received a certain diagnosis for a condition, but much stronger, more convincing evidence would be the actual medical record in which the diagnosis was stated or a statement from the doctor who made it.
Expert versus lay testimony. Related to the last point is that those to provide evidence must be “competent” to do so. This is a legal term that basically means, possessed of the knowledge, training or experience to reliably say what is being said. Thus, a family member could be perfectly competent to say that a veteran had a limp when she returned from service, but unless that family member is a doctor, he is not competent to say that the veteran had a hip dislocation; the latter requires medical training and judgment. Don’t overlook, though, the capability of lay persons to competently attest to what they can clearly see or perceive.
Corroboration. Although it is supposed to be neutral, VA in fact views anything a claimant says as suspect, because there is always the possibility that the claimant is fabricating or exaggerating something in order to get money from the government. This factor can be offset through corroboration: records or other witnesses who can verify what the claimant is saying. Even a writing made by a claimant can serve to corroborate, if the record was made contemporaneously with the event, e.g. jotting down immediately afterward what happened during a medical exam or an accident. If reliance must be placed solely on a claimant’s recollection, it can be strengthened through detail that increases the plausibility of the story. Needless to say, any hint of falsehood or inaccuracy seriously undermines the value of evidence.
By paying careful attention to whether you have evidence on each of the key facts, and observing the preceding tips for making that evidence as persuasive as possible, you can significantly improve your chances of VA making a favorable decision initially, but even if it doesn’t, you will have vastly improved your chances of a successful appeal and eventual favorable decision.

David E Boelzner FAQs, Veterans Benefits Claims veterans disability benefits

     In a previous blog posting I discussed evidence in general and the benefit-of-the-doubt rule. I also mentioned the three essential facts that must be proven in a service-connection claim: that there was an injury or first manifestation of disease in service, there is a current disability, and the disability is causally related to the event in service. Medical evidence is crucial to two of these three elements. Unless a disability is so obvious that a lay person can discern it, an amputated limb for example, evidence from a medical provider of some type is necessary to establish that there is a physical or mental condition that is disabling. On the important question of medical causation of a disability, whether the current condition is related to something that occurred in service, the evidence is usually in the form of expert opinion from a doctor or other health-care provider. Even if service connection is established, in order to obtain a higher rating for the condition, there must be medical evidence of the severity of the disability.
     In the old days, panels of the Board of Veterans’ Appeals had at least one doctor on them and they evaluated medical issues, but under present law the VA is not permitted to decide medical questions based on its own judgment without expert opinion to support its decision. Precisely because this evidence must generally come from a medical professional, it is often the most difficult aspect of a claim for veterans to establish.

Sources of medical evidence
     It should be noted that medical opinions do not necessarily have to come from doctors. While the strongest opinion might come from a specialist in a particular area, e.g. a psychiatrist rather than a family doctor concerning a mental condition, anyone with medical training can render an opinion. Thus, PTSD diagnoses have been based on the opinions of social workers or trauma counselors who are not MDs. Depending on the issue, a nurse could be at least as persuasive as a doctor, regarding, say, what hospital treatment would have been.
     Diagnosis of a disability and the severity of impairment caused by that disability can frequently be proven by medical records from health care providers who have treated the claimant. Sometimes a treating physician must be asked specifically to comment on the subject, but he or she is usually willing to do so. More challenging, sometimes, is obtaining the opinion that a present condition is related to an event in service, what VA law calls a “nexus” opinion. This type of opinion statement is rather specialized and must be written in a certain way.
     Some medical cause-and-effect relationships are quite apparent: the damage done by a gunshot wound, the scar caused by a laceration, the bone fracture resulting from a trauma. But many such relationships are less clear, such as the relationship between a trauma to a joint and development of arthritis in the joint many years later, or the connection between some frightening or stressful experience in service and later manifestation of mental disease. These relationships are determined through the judgment of medically-trained people.
     Medical causation is often a matter of probabilities. It cannot be determined with certainty, for example, whether a back injury in service caused or hastened the onset of degenerative arthritis in the back many years later, but doctors will often be able to offer an opinion as to the likelihood of a relationship. Thus, one doctor might be of the opinion that too much time has passed for an isolated injury in service to have been the likely cause of arthritis, while another doctor may believe that the trauma to the back made the joints more susceptible to degeneration and thus contributed to causing the arthritis. To support the claim, the veteran needs an opinion that there is a relation to service, at least as likely as not.
      It is because of the benefit-of-the-doubt rule that medical opinion reports in veterans cases contain language using some variation of the phrase “as likely as not.” As long as the probability of causal relation is 50-50, that is, “as likely as not,” the evidence is balanced, and the benefit-of-the-doubt rule tips the decision in the veteran’s favor. That is why you will so often see medical opinions stated in terms of “as likely as not” or something similar.
Doctors familiar with the VA system usually have some notion about how to phrase opinions in this way, but doctors who have not had experience with the VA claims system will not. Indeed, many doctors have some acquaintance with a significantly different standard used in civil litigation: “to a reasonable degree of medical certainty.” Because veterans need only prove elements of their claims as likely as not, i.e. to a 50-50 probability, they do not have to show medical “certainty” to a reasonable degree, which is a more exacting standard. When this is fully explained, a doctor will sometimes be able to see her way clear to offer an opinion that she would not have been able to offer under the stricter standard. That is, a doctor may be uncomfortable, based on existing medical science and literature, saying that Agent Orange exposure caused a particular cancer to a reasonable degree of medical certainty, but may not be so hesitant to say it is at least as likely as not that the defoliant caused the cancer.
     It is also important for doctors writing opinions to support veterans’ claims to bear in mind that something does not have to be a sole cause to be related sufficiently to establish service connection. If the in-service event or condition was a contributing factor to a later disability, that is enough to sustain the claim.
The court that reviews VA decisions has recently expounded more detail about how medical opinions are to be considered by VA. The essential features are that the provider expressing the opinion must have had the appropriate data available, must state clear conclusions based on that data, and must give a reasoned explanation linking the conclusions to the data. Thus, any opinion obtained in support of a claim should contain a statement as to what was reviewed, whether a physical examination was done, what the opinion is, and what the rationale for the opinion is.

NEXT TIME: How VA gets around the benefit-of-the-doubt rule and what you can do to counter this.
 

David E Boelzner FAQs, Veterans Benefits Claims Veterans Benefits Claims, veterans disability benefits

Many veterans pursuing a claim for VA benefits have already been granted Social Security Benefits or are pursuing Social Security benefits for the same disability. A common belief among veterans is that VA should make the same conclusions and/or decision as the Social Security Administration (“SSA”). For instance, many veterans believe that because SSA found them totally disabled, that decision should be binding on the VA, and therefore VA should also find them totally disabled. This is a common misconception. VA is a separate administrative agency form SSA, and therefore is bound by different regulations. Simply put, SSA regulations do not apply to VA claims. See Beaty v. Brown, 6 Vet.App. 532 (1994) (noting that there is not statutory or regulatory authority for the determinative application of SSA regulations to the adjudication of VA claims.) In addition, there are significant differences between SSA regulations and VA regulations. For example, SSA and VA define disabilities differently. Under SSA law 42 U.S.C. § 423(d) and 20 C.F.R. §404.1509, a disability need not be reasonably likely to last a lifetime. VA regulations on the other hand, do require that it be reasonably certain that a disability will continue throughout the life of a person. 38 U.S.C. §1502(a)(1) and 38 C.F.R. § 3.340(b).
While VA is not legally bound to follow SSA decisions, however, it is obligated to take the SSA decisions into consideration when rendering a decision on a claim and provide adequate reasons or bases for why the SSA conclusions are not accepted. Brown v. Derwinski, 2 Vet.App. 444 (1991). Moreover, once VA has been put on notice that SSA documents exist, and those documents are pertinent to the VA claim, VA has a duty to assist the veteran in obtaining the SSA records prior to adjudicating the claim. See Murincsak v. Derwinski, 2 Vet.App. 363 (1992).

Nancy L Foti FAQs, Veterans Benefits Claims veterans disability benefits

“Evidence” is a subject law students devote considerable effort in studying, and it can present complexities even to the best legal minds. But it is quite possible and useful to understand the basic concepts as they relate to the veterans claims system, which is in some ways unique in this regard. You will have a better chance of obtaining benefits from the VA if you understand what you have to provide in the way of evidence to support your claim. It is perhaps worth a reminder that VA does not award benefits based on service to country, however dedicated, or on sympathy for a veteran’s hardship, however difficult; it can award only where evidence shows entitlement.
Evidence and elements of claims
“Evidence” refers to the information, whether from witnesses, written statements, documents or other records, that is considered and evaluated by an adjudicator in making a decision on a claim. Every legal claim has certain “elements” that must be proved, that is, certain points that must be established as true to the adjudicator’s satisfaction before the claim can be won. Thus, in a manslaughter case, for example, the prosecutors must prove that the accused caused a death and did so through carelessness, while in a first degree murder case the prosecutors have to show that the accused not only caused the death but intended or planned for it – different elements for different crimes. In a classic veteran service connection case, the elements that must be proven are (1) an incident in service, i.e. an injury or first manifestation of a medical condition, (2) a current recognized disability, and (3) a causal relation between (1) and (2), i.e. the disability is the same condition or related to the incident in service in some way.
Standards of proof
The key facts of a legal claim must be proved to a particular degree of certainty, which varies depending on the type of claim. In a criminal case, the law requires proof “beyond a reasonable doubt,” that is, the decision-maker (often a jury) must be so convinced of guilt that any doubt about it would be unreasonable in light of the evidence. This is a difficult standard of proof; the view of the law is that before a person is deprived of his liberty, or even his life in some states for some crimes, there should really be nearly absolute certainty about guilt. In an ordinary civil case, such as a personal injury claim arising from a car accident or a contract dispute, the standard of proof is simply that the evidence is slightly stronger in favor of the claimant (plaintiff), even if only by a small degree. If the evidence is so balanced that the adjudicator can’t decide one way or the other, the plaintiff has failed to meet her burden and the defendant wins. Lawyers call this standard the “preponderance of the evidence,” from the idea that the evidence “weighs” slightly heavier in one direction.
Benefit of the doubt
When Congress established the veterans claims system, it wanted to make it as friendly to the award of benefits as it could and still require proof that benefits were appropriate. So it passed a law, found at § 5107(b) of Title 38 of the United States Code, which says that when there is an approximate balance of evidence (what lawyers often call “equipoise”) on any point crucial to the decision, the benefit of the doubt is to be given to the claimant. In terms of the evidentiary standards discussed above, this means that a veteran claimant does not have to provide proof as convincing as a civil litigant under the preponderance standard: if the evidence in a civil case were more or less balanced, the claimant would lose, but the veteran is supposed to win in that circumstance. It is equivalent to the old baseball rule: tie goes to the runner.
Practical application; “as likely as not”
How do these abstract legal concepts work in actuality? Let’s say the issue in question is whether a soldier hurt her head in a bad fall in service. She remembers (years later) that she had a headache immediately after the fall. A record of sick bay treatment right after the incident does not mention a head injury but discusses other more pressing concerns: bleeding and a compound fracture of one arm. A follow-up record two days later notes, in addition to the progress of healing of the arm, a small bruise on the forehead. VA might dismiss the veteran’s recollection years later as flawed or possibly self-serving and regard the absence of any mention of a head injury in the treatment note on the day of the accident as evidence that there was no such an injury. But the fact that there were more urgent injuries to address in first aid and the mention of the bruise in a record a couple of days later supports the veteran’s recollection. As lawyer for the claimant I’d argue that this evidence weighs more heavily in the veteran’s favor, that there is a preponderance of the evidence, but, at the very least, this would seem to present an approximate balance: there is some evidence of a head injury and some indicating none occurred, but neither is overwhelming. Under the benefit-of-the-doubt rule, the veteran wins.
NEXT TIME: The special issue of medical opinion evidence.

David E Boelzner FAQs, Veterans Benefits Claims Veterans Disability claims

One of the most common complaints we hear is that it appears that VA took away part of a veteran’s service connected disability compensation benefits when it granted an award. That is, VA awarded an increased disability rating, but the overall compensation did not change, or the disability ratings assigned do not “add up” correctly. So it appears VA granted more benefits with one hand, but took away all or part of them with the other.

This normally occurs when VA awards a veteran a compensable (greater than 0%) disability rating for two or more disabilities. For example, a veteran may be awarded compensation at the 60% rate for one disability and the 50% rate for another disability. Simple math dictates that the veteran is entitled to a 110% disability rating. However, VA did not award a 110% rating; rather, it awarded an 80% disability rating, which appears to be a 30% reduction.

Congress permits VA to award disability ratings from 10% to 100%, in 10% increments, for a “schedular” disability rating. No award can be greater than 100% on a schedular basis. To know if a disability has been rated as “schedular,” – that is, based on VA’s Schedule of Rating Disabilities – there usually is a four or eight digit code numeric and a percentage assigned to the disability within the rating decision. (VA may assign extraschedular ratings or special monthly compensation, which are benefits generally beyond those permitted by the Schedule, but these benefits are outside the scope of this post.)

Because Congress does not allow disability ratings greater than 100%, VA cannot assign a higher disability rating. In other words, this is the upper limit of what VA can award on a schedular basis. When a veteran carries a 100% rating, he or she is considered totally disabled; the law uses the phrase “a total rating” to describe a 100% disability rating. Regardless of the number of disabilities or how great the aggregate disability ratings, no veteran may be assigned a disability rating greater than 100% or be more disabled than “total” for VA rating purposes.

The “110% disabled” veteran may then ask why VA did not simply award him 100% disability, since the ratings show him to be more than 100% disabled? VA uses a somewhat complicated formula to determine how each of these disabilities affects the veteran, and that formula is what is responsible for “VA math” – that is, the apparent reduction in the overall disability rating.

Disabled veterans, of course, may have multiple disabilities. Independently rated, the sum of each disability rating is often larger than what VA actually awards. This is so because VA uses the Combined Ratings Table at 38 C.F.R. § 4.25 to calculate how various disability ratings are combined into an award. According to § 4.25, VA considers the effects of the most disabling condition to the least disabling condition on the veteran.

This is how it works, for example: If a veteran carries a 60% disability rating, he or she is 40% efficient (non-disabled). Stated another way, this veteran retains 40% of the ability to work. If that same veteran also carries an additional separate 30% disability rating, of the 40% of his or her original efficiency that previously remained, he or she lost 30% of that 40% (that is, he or she retains only 70% of that 40%). This leaves the veteran only 28% efficient, or 72% disabled.

It may be easier to think of it this way: Presume you have a 10 ounce glass of water, and you pour out 60% of that water. What is left is 4 ounces, or 40% of the water. Of that water that remains, you pour out another 30%. That is, only 70% of the 4 ounces remains. There is now only 2.8 ounces, or 28%, of the water that was in the full 10 ounce glass; 7.2 ounces, or 72%, of the water is now gone.

Analogous to the glass of water is a veteran’s disabilities. In this scenario, ordinary math would result in a 90% disability rating, but when the ratings are combined using the formula in § 4.25, the veteran is considered 72% disabled.

Because Congress only authorized disability ratings in 10% increments, VA rounds the final calculation to the nearest 10%, rounding the end number of 1-4 down and of 5-9 up. Therefore, VA will award our veteran a 70% disability rating.

The same considerations apply for the “110% disabled” veteran as those who have ratings of less than 100%. Using VA’s combined ratings formula, the 60% and 50% disability ratings combine to create an 80% disability rating. If the veteran is service connected for another disability, then that disability will be factored into the overall award. In the alternative, had the veteran already obtained a 100% rating, VA would ignore the additional award out of necessity.

Because of “VA math,” not every award will result in additional compensation. Say VA awards this same veteran, who has an 80% disability rating, an additional 20% disability rating for another disability. The overall compensation award would remain the same! VA takes the 80% rating and factors the 20% additional disability onto that, resulting in an 82% rating, which rounds down to 80%. Therefore, it appears that VA ignored the new 20% award! It did not; that is just the way VA math works.

The Combined Ratings Table can be found here: http://edocket.access.gpo.gov/cfr_2005/julqtr/pdf/38cfr4.25.pdf

Todd M Wesche FAQs, Veterans Benefits Claims

We frequently hear complaints from our clients that VA is taking a long time to render a decision on a claim for VA benefits. Given the enormous backlog and understaffing from which VA suffers, this is to be expected.

In fact, delay is inherent in the VA system. After a claim is filed, VA must provide notice to each claimant regarding the information and evidence necessary to substantiate the claim. VA must allow claimants one full year for the submission of that information and evidence before it can decide the claim, although it may decide it faster if the claimant indicates that there is no additional information or evidence to submit. Further, VA must obtain certain records possessed by the federal government and other records that are relevant to the claim if adequately identified by the claimant. Also, if necessary to make a decision on the claim, VA must also provide the claimant with a VA examination or obtain a VA medical opinion. VA must then review all of the evidence and determine whether there is enough to decide the claim and, if not, it must continue working to develop that evidence.

Of course, each step in the process takes time. Ideally, VA should also provide claimants with notification of what is happening on the claim, but it does not always do so.

At some point, it becomes clear that VA is not taking any action on a claim. This may become apparent through the passage of an extraordinary amount of time since the last VA action on a claim, or VA may expressly say that it will not take a particular action, despite repeated requests for it to do so.

As a first step for prompting VA to act, sending a letter to VA asking for a status on the claim or asking it to take the next step may work. At a minimum, the letter requires VA to pull the claimants file from the shelf and look at it. This may be sufficient for VA to realize the next step that needs to be taken and to do so.

A single letter however may not prompt VA to act. When this happens, we have a tool we can use to prompt VA to act. This tool is called a “Petition for Extraordinary Relief in the Nature of a Writ of Mandamus.” Or, simply, a writ petition. Writ petitions are separate actions that are filed in the U.S. Court of Appeals for Veterans Claims that assert that the Secretary of Veterans Affairs, through his personnel, is refusing to take an action that legally must be taken. Such refusal can be shown through the passage of time or through other proof that VA is not acting on a claim in the way it is legally required to do. Notably, writ petitions cannot be used as a substitute for an appeal of an unfavorable VA decision, and they cannot be used to force VA to grant a claim that was otherwise denied.

Before filing a writ petition, a letter should be sent to VA threatening to file a writ petition. The letter should be sent by certified mail, return receipt requested, to prove VA received the letter. The letter should state that, unless VA responds within a certain amount of time (for example, 10 days), a writ petition will be filed in the Court.

If VA fails to respond to that letter, then a writ petition may be necessary. Before involving the Court, it must be determined whether there is a legal basis for filing the petition. Such a circumstance would be where VA has expressly stated it will not take a particular legally required action. If delay is the basis of the petition, then that delay must be so extraordinary as to amount to an arbitrary refusal to act. A few months will not generally suffice, but a delay of more than a year may, depending on the circumstances.

A writ petition must provide a facially valid basis for the Court to grant the petition. If so, the Court will require VA to respond to the writ within a short period of time – generally one month.

Ordinarily, VA will then take some action on the claim. That action may be as little as sending a letter to the claimant or it could be as much as a grant of benefits, or whatever the next legally-required action on the claim may be. If so, this will make the writ petition unnecessary (that is, moot), because VA has taken the action it had refused previously to take. Although not technically a win on the petition, VA’s response to the petition by acting on the claim amounts to a successful resolution.

Sometimes, however, VA will defend its actions and continue to refuse to act. In those circumstances, the judges on the Court will decide whether VA’s defense is valid. If not, the judges will order VA to take the action requested. VA is then under a court order to do so.

Although many writ petitions are filed, the Court grants very few. In fact, since the Court’s creation in November 1988, it has granted fewer than five writ petitions. Even though this represents only a small fraction of the number of writ petitions filed, the writ petition remains a useful tool for prompting VA to act.

As always, it is wise to consult with a legal professional before filing a writ petition. This blog is not intended to provide legal advice, and it should not be relied upon as such.

Todd M Wesche FAQs, Veterans Benefits Claims veterans disability benefits

When you called to follow up on the claim you submitted, you were told that VA never received a claim from you and they have no record of your ever filing one. Or they asked you to submit medical records, and you just sent them those records a few months ago – but the folks at VA tell you that those records aren’t in your files.

Maybe they got shredded – or are just in a desk drawer somewhere. Last fall, we heard a lot about the claims information found in shredder bins at various Regional Offices. Yesterday (March 3, 2009), the House Committee on Veterans Affairs held a joint hearing of the Oversight and Disability Assistance and Memorial Affairs Subcommittees on “Document Tampering and Mishandling at the VBA.”

Belinda J. Finn, Assistant Inspector General for Auditing of the Office of Inspector General, described the results of the investigation into the shredding incidents. She also discussed the results of “mail amnesty” programs:
“VBA officials also said that some VAROs held “mail amnesty” periods to encourage employees to turn in unprocessed mail and other documents without penalty or repercussions. During an amnesty period in July 2007 at VARO Detroit, VARO employees turned in almost 16,000 pieces of unprocessed mail including 700 claims and 2,700 medical records and/or pieces of medical information. The VARO determined that none of these claims or documents were in VBA information systems or associated claim files. VBA management told us of similar amnesties at other VAROs, such as an amnesty at VARO New York in December 2008 that recovered 717 documents from VARO employees.”

You can find all of the testimony at the House Committee on Veterans Affairs website,
http://veterans.house.gov/hearings/hearing.aspx?newsid=340

What can you do now to try to fix the situation? VA has established special procedures for claims or documents submitted between April 14, 2007 and October 14, 2008. If you submit a duplicate, and tell them that you submitted it during these dates, it will be treated as submitted on the date you originally submitted it. Between November 17, 2008, and November 17, 2009, VA will accept claims asserting that they were actually submitted during the earlier period, and the effective date of the claim will be the date when you originally submitted the claim.

VA has set up a website for information about the shredding incident and the “special handling procedure” that it has established for claims and documents submitted between April 14, 2007, and October 14, 2008. You can find this information at

http://www.vba.va.gov/VBA/SpecialProcedures_qa.asp

Sandra W Wischow FAQs, Veterans Benefits Claims FAQs, Veterans Benefits Claims