Segmented Lanes: a Process for Claims

Working at one of the Big Six Veteran Service Organizations taught me a few things about VA. First, the regional offices that process compensation claims are not equal, some are more consistent. But the most important thing I learned during my three years representing Veterans who filed appeals to the Board of Veterans Appeals is this: NO CLAIM IS THE SAME. I learned while some claims may appear similar, little variances in each make all the difference.

The Veterans Benefits Administration’s Transformation Plan is change of giant proportions. We’ve tested and measured more than 40 initiatives that are in some phase of implementation. Each initiative falls into one of three categories: people, process, or technology. It’s not enough to change only our processes, update technology, or only change the way we train our employees. VBA Transformation must take place across all three fronts.

Segmented Lanes is one of our new processes that we have implemented at 16 regional offices. The rest of our regional offices get Segmented Lanes throughout 2013. When you file a claim or send evidence to support your claim, our Intake Processing Centers sort it into one of three Segmented Lanes: Express, Core, or Special Operations. This allows VBA to identify at the earliest possible point any Veteran who requires expedited handling, such as a Veteran experiencing financial hardship, a homeless Veteran, a Veteran over the age of 75 or a Veteran who has a terminal illness.

For the rest of us, Segmented Lanes helps get our claims processed faster, in the hands of the right processor, increases accuracy and standardizes the process across all regional offices. This means that the process at the New Orleans Regional Office is the exact same process at the Salt Lake City Regional Office.

The lanes break down like this:

Express Lane: claims that have one or two contentions, or fully developed claims (an example would be if a Veteran files for an increase in compensation for a back issue and is also seeking to have her left hip condition service connected)
Core Lane: claims that have three or more contentions, or any claim that does not meet the criteria for Express or Special Operations.
Special Operations: All claims that require special handling because of their nature (examples are Post Traumatic Stress Disorder associated with Military Sexual Trauma, former Prisoners of War, Traumatic Brain Injury).
Each lane has dedicated claims processors whose skills and expertise match the lane to which they are assigned. This is how VA will process claims more quickly and more accurately. While no claim is the same, certain aspects of processing are alike, so if you work similar claims the process naturally speeds up and quality increases. When I worked at the Board, I often worked several claims in a row for disorders that resulted from a Military Sexual Trauma because some of the same regulations applied to those claims (like rating criteria), even though the claims themselves varied dramatically. Not having to refer to different parts of the regulations saved time, but I also became really good at claims resulting from MST. If I worked at a regional office today, I would probably be in the Special Operations lane.

Another way the lanes are ensuring speed and quality is through our Fully Developed Claims program. FDCs are claims where the Veteran certifies at the time they submit the claim that he or she has provided all evidence. That certification allows VA to move forward without waiting the mandatory waiting period for the Veteran to submit evidence. Veterans can file an informal claim stating they intend to file a claim for benefits using FDC to preserve an effective date and allow them time to collect evidence. We have assigned these claims to the Express lane, allowing FDC claims to be determined in an average of 100 days.

Veteran Service Organizations are available to help Veterans, their families and survivors file claims using both the traditional process and the Fully Developed Claims process. They provide this service regardless of whether you are a member. Let them help you.

Segmented Lanes is just one part of our Transformation and as such and it alone will not eliminate the backlog. But collectively, the initiatives will give VA the ability to process all claims within 125 days at 98 percent quality.

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How Veterans Can Successfully File a VA Compensation Claim

There are two ways to file a VA compensation claim: print the 526EZ and mail/fax it, or submit it electronically through VA and DoD’s eBenefits web portal. Most Veterans opt for the former, cross their fingers, and hope for the best. But unless you are just leaving the military, with well-documented and easily accessible service treatment records, this isn’t the best approach.

Intent to file
The Intent to File is required, but here’s why it’s a good thing: It immediately establishes your effective date for pay purposes. Best of all, it only takes a few minutes to complete online in eBenefits. (You can submit your Intent to File online in eBenefits here)

We know that it may take you some time to gather all the evidence you need to support your fully developed claim (FDC), such as your service treatment records, private treatment records and DBQs, and written witness/buddy/commander/spouse/lay statements. The Intent to File for a VA compensation claim lets VA know that you are planning to file a claim, and it locks in your “backpay” date. You then have one year to complete your claim application.

What info does VA need from me?
To receive VA disability compensation, you must meet three criteria: an event in service that caused or aggravated a disability or illness; a current diagnosis of a medical disability or illness; and a medical opinion connecting the two (the latter as a result/because of the former).

Event in service is something that happened in service that caused or aggravated your current disability. For example, you fractured an ankle in service and now have arthritis in that ankle. Or, you served in Vietnam, were exposed to Agent Orange, and now have a disease that is considered presumptive for Agent Orange exposure;
A current VA or private doctor’s diagnosis showing that you have a medical condition related to the service event; and
A doctor’s opinion that the event in service and current diagnosis are connected. This is called the nexus. Unless the connection is obvious through your medical records, this opinion, or nexus, will usually come from your VA-scheduled Compensation & Pension (C&P) exam. For presumptive illnesses, VA presumes the connection between the documented event in service and the current diagnosed illness. In this case the nexus is established by law.
Without all three of these items, a VA compensation claim can’t be granted. It’s like a three legged stool – without any one of these legs, the stool will fall over. If you provide evidence of the first two items but not the third, VA will schedule you for a C&P exam to determine a doctor’s opinion for the third. Be aware that just because a doctor’s opinion is requested on service connection that that doesn’t mean a doctor will agree that your current condition is related to your service.

Write a statement in support of your claim
When filing your VA compensation claim, include a VA Form 21-4138. This is called the Statement in Support of Claim. It’s important to write a separate paragraph for each disability you are claiming. It’s equally important to explain how the event in service (be specific) affects your current disability or symptoms related to your injury or illness. Provide every piece of evidence from the event that you can think of, such as personnel records, award narratives, pictures, medical records, unit profiles, prescriptions, etc. If you don’t think this event is in your service personnel or medical records, find someone you served with to fill out a form to provide their witness statement to the event. While a witness statement alone usually is not enough to grant a claim, it can be combined with other evidence to strengthen a claim for service connection.

Your statement is considered evidence, just like your military or treatment records, and the rater will use it to make the decision. It also tells the rating team where to look in your records, and the timeframe for information to validate your claim.

Include medical records
VA can access treatment records from other VA and military medical facilities, but don’t assume that “VA has everything it needs.” Remember above: VA and military records are just one leg of the three-legged stool.

If you have your service medical records, include them as evidence. It also helps VA if you include where it was that you’ve been treated for your medical conditions on your application (name of treatment facility). You should also highlight the pages and passages that refer to your medical conditions, such as lab results and diagnoses, which may eliminate weeks or even months of processing time. Providing all of this information with your claim will help the rating team process your claim more quickly.

If you don’t have your service records, VA will request them from your military branch archives, but this can take several weeks or more. If you don’t have them and would prefer to request them yourself, contact the National Personnel Records Center (NPRC) here.

Compensation and Pension: Your C&P exam
Even if you submit all of your medical records, you may still be asked to go to a C&P exam. This is not a typical doctor’s exam. You won’t be diagnosed or treated, and in some cases, the doctor may just review your records—including any statements in your file—and ask you a few questions. While this may seem unusual for an exam, the doctor is actually filling in a Disability Benefits Questionnaire (DBQ), which the rater will use to determine if your claim can be granted, and at what percentage.

So, in the exam, be honest and specific with your answers. For example, if the doctor asks about an injury, instead of saying “I hurt my back in the service,” you should say “I was getting something off of a shelf in the warehouse and fell off a ladder. There is an accident report. My back has given me problems ever since.” This allows the doctor to connect an incident in service to the current disability, and the DBQ the doctor submits will contain an opinion that your disability is either more- or less-likely than not connected to your service. That’s the third leg of the stool.

What if I need help?
If all of this sounds like Greek to you, then you should either follow our helpful tutorials on YouTube that walk you through the VA compensation claim application process, or enlist the help (FREE) of a Veterans Service Organization (VSO) to assist you.

Then what?
Once you or your VSO has submitted your VA compensation claim, you can check on its current status in eBenefits (hover over “Manage,” then click on “View or update your Compensation and Pension (C&P) claim”). On the status page, you can view more detailed information by clicking on the claim date.

It’s important to note that, once you have submitted your fully-developed claim online, or by mail/fax, you are telling VA that you have no further evidence or information to submit. Submitting un-requested evidence or information after it has been submitted will cause a delay in processing.

Did you know?
By providing a more complete picture of your situation to the rating team when you file your VA compensation claim application, you not only make it easier for the raters to find your information and process your claim, but you also increase your chances of having your claim granted. Although it will take a little more effort on your part, it can pay off with faster VA processing, and will increase your chances of a successful claim the first time.

Remember, the rating team—most of whom are Veterans just like you—is on your side, but you can help them by including everything they need to approve your claim.

VA Apprenticeship Program to Train, Employ Veterans to Assist other Veterans in Properly Filing for VA benefits

Veterans service organizations (VSOs) play a major role as advocates for the Veteran community, and as partners with VA, to ensure this nation’s Veterans receive the benefits they have earned. An important part of this partnership is to support VSOs as they train their advisors on the benefit process.

VA’s Vocational Rehabilitation and Employment (VR&E) program recently entered in to an agreement with Paralyzed Veterans of America to participate in an apprenticeship program to train Paralyzed Veterans’ employees on how to assist Veterans to file for and obtain their benefits. A similar program is currently in effect with the Disabled American Veterans organization.

Paralyzed Veterans is an advocate for quality health care, spinal cord injury and disease research, VA benefits, and civil rights for Veterans and all people with disabilities. As a service oriented non-profit organization, Paralyzed Veterans employs national service officers to serve Veterans.

“The apprenticeship program with Paralyzed Veterans will put much needed resources into communities nationwide to work with our Veterans and assist them in applying for benefits,” stated Tim Johnston, supervisor for rehabilitation services at VR&E. “This not only gives those accepted into the program a skill, but ensures that Veterans in communities, large and small, have access to trained professionals who can help them understand the process and apply for those benefits they have earned and deserve.”

In a memorandum of understanding between the two organizations, Paralyzed Veterans will provide a 36-month on-the-job training program to qualified Veterans who are selected for the apprenticeship program. Most of the apprenticeship is supervised work with some classroom and on-line learning. These are full-time national service officer positions.

Pay during the apprenticeship is supplemented by the VR&E program. For the first 12 months, those selected for the program are paid $2,890 per month by Paralyzed Veterans, and an additional $651 from VA as a training allowance. In the remainder of the apprenticeship, Paralyzed Veterans pays $3,166.66, and VR&E pays $375 per month for training. The VR&E training allowance to the Veteran is tax-free. VA also pays for the training and necessary supplies.

Selection for the program generally comes from two sources. Paralyzed Veterans may notify VR&E that they have a candidate in mind, or a VA vocational rehabilitation counselor can recommend someone for the program.

The current memorandum of understanding will be in effect until May 2021.

How to apply

To be considered for this program, you must be receiving services from VA’s Vocational Rehabilitation and Employment  program. If you are not receiving services from the VR&E program, but would like to, you will need to apply.

To apply to VR&E, please go to eBenefits and click on Vocational Rehabilitation and Employment under Apply.  You may also submit a completed application (VAF 28-1900) at the local VA Regional or outbased office, or mail the completed application to the closest regional office. Remember: not all Veterans are eligible for VR&E benefits, but to become eligible, you must have a service-connected disability of 10 percent or more.

Next, after establishing eligibility, you must also be determined entitled for services under VR&E. Entitlement is based on the Veteran having an employment handicap affecting their ability to obtain and maintain employment. It is after you have been found entitled and you have had an opportunity(ies) to meet with your vocational rehabilitation counselor that you will discuss your interest in the apprenticeship program. If the apprenticeship program seems like a good fit, the counselor may recommend you for the program. Additionally, there must be a need within the local Paralyzed Veterans of America office for a trainee.

Paralyzed Veterans may also notify VR&E that they have a candidate in mind. This candidate must also be receiving VR&E services, or they will need to go through the process explained above.

If you have any further questions, please contact your local VR&E regional office

VA Compensation 101: What Exactly is VA Compensation?

As a social media administrator for VA’s Benefits Administration, I read thousands of comments (yep, all of them) each week from thousands of people scattered across the country. It’s no surprise that the most-talked about VA benefit is VA compensation, but it is sometimes surprising that the words we use to talk about this benefit are different from the words used by those in our social media community. Even more surprising is that many don’t fully understand the intent, purpose or process behind this benefit.

That’s on us, I guess, that we need to reach more of you to better explain what compensation ishow it works, and who can get it. In general terms, this blog intends to do just that. Or, more loosely: here’s the skinny, the straight talk, with no PR, no spin, no BS.

Ready?

So, what is compensation?

It’s money, obviously. But there’s more to it than that. People often say it’s their “monthly check,” their “service-connected payment,” “their disability payment,” or even simply their “benefits.” These are actual words I often see, but even they don’t effectively describe what compensation is, nor do they accurately portray which specific benefit—among dozens VBA administers—they’re referring to.

There are several types of VA compensation, but I’ve learned that most people are most often referring to disability compensation. When referring to disability compensation, people most often say “my claim,” “my money,” “my benefits,” or “my check.” Sometimes they even say “my pension,” which is, itself, an entirely different and unrelated VA benefit.

Alright, I’ve dragged you along long enough, What IS VA compensation?

  • First of all, it’s taxpayer money. Every year, VA makes a budget request for the following year. In simple terms for just VBA, we look at what we’re currently paying to administer VA benefits, including how much we’re paying in compensation to the millions of Veterans on the rolls, then we analyze how much more we’ll need based on many factors, mostly that there are more Veterans now accessing and receiving and applying to more VA benefits. However, VA’s budget does not limit what we can pay in benefits.
  • Secondly, to safeguard taxpayer money, disability compensation is a process. There are federal laws that govern how we, the VBA, can administer it. This is a protection to the taxpayer to prevent abuse and fraud.
  • Next, maybe most importantly—and the part you care about most: VA disability compensation is a tax-free, monthly payment to eligible Veterans for the injuries and medical conditions they incurred/acquired/caught/received or aggravated while in active military service.
  • But VA compensation is also an acknowledgement. An acknowledgement implies acceptance from the federal government that what happened to you in service can or may affect you after service. And that’s a broad, vague statement. Thus, VA compensation makes up for the potential loss of civilian wages or civilian working time you’d miss as a result of, or for tending to (appointments, etc.), your injuries/medical conditions. It’s basically the government saying, “Hey, thanks for your service. You sacrificed your health for America, so we accept that your reduced health may impact your ability to live as comfortably as you would had you not gotten hurt/sick.”
  • Lastly, VA compensation is not income. I’m going to say that again: VA compensation is not income. It is not a replacement or substitution for civilian employment, and it is not a military retirement. Except in uncommon situations, VA does not pay you to not find or hold civilian employment. Compensation makes up for; it doesn’t replace.

Those are the basics. That’s what it is. In my next blog, I’m going to lay it straight for the questions that would logically follow: Who is eligible, How does it work, and What do I need to do? If you like this approach and you want to see more blogs like it, shoot me some suggestions in the comments below, or hit me up on the VBA Facebook page where I chat with Veterans everyday.

VA Claims Corner: The Importance of VA Medical Exams

Remember when you were in the military and your commanding officer or staff NCO threatened to “write you up” because you failed to get your vaccination or resolve another medical issue near deployment time? Back then, you didn’t have to be as proactive with your medical appointments because safety nets were in place (thanks to your gunny/first sergeant/senior master sergeant/chief petty officer!) to make sure you made it to sick call.

The transition from military to civilian life can make remembering to attend your scheduled medical appointments a little tricky – especially if you’re in the middle of a job search or attending college for the first time. However, it’s important you know that making your scheduled VA exams is essential to accurately processing your claim. VA assesses your exam results when determining service connection for your claimed medical condition. These medical examinations are scheduled by VA and are performed by either a VA physician or contracted physician. It’s important to note these exams aren’t always required to evaluate your medical conditions; however, in instances when they are needed, it’s important that you make every effort to show up!

During my time as a Veterans Service Representative, I would periodically see cases where a Veteran failed to report to his or her medical appointment. While we certainly understand that life can get in the way, missing an exam can have huge ramifications to your benefits to include:

  1. Denial of your original or reopened claim, or claim for increase. When you fail to report for an exam, your claim will be rated based on the evidence available in your record. This could be detrimental to your original claim because the exam results could provide the necessary evidence needed to satisfy service connection. In reopened claims, the exam results may provide the new and material evidence needed to overturn a prior VA decision or, in the case of a claim for increase, show that your condition has worsened.
  2. Reduction or termination of your current benefits. When you fail to report for a reexamination of a running entitlement, VA, under law, is required to issue you a notice that proposes to either reduce or terminate your monthly benefit if an examination is needed to maintain a current rating.
  3. Delay in the decision of your pending claim. Examination requests are in high demand. Rescheduling can delay the processing of your claim and a final decision from VA.

In order to avoid these potential pitfalls, follow these simple tips:

  1. Keep your scheduled exam whenever possible.
  2. Can’t make it? Tell VA immediately by phone, online, or in person. We may be able to reschedule your exam date.
  3. Make sure your address and phone number is up-to-date in eBenefits. VA will attempt to notify you of an exam by letter and telephone. I’ve personally seen countless amounts of returned mail because applicants moved without notifying VA. The easiest and quickest way to update your address and telephone number is through eBenefits.

More information on this topic can be found in 38 Code of Federal Regulation 3.655.

As always, if you still have questions, a VA representative or a Veterans Service Organization may be able to help.

VA Pension Provides Support for Qualifying Veteran Survivors

When Veterans and their family members think of VA benefits – the first thoughts that typically come to mind are VA’s educational benefitscompensation and health care benefits, or home loan benefits. Many don’t realize that VA also offers a benefit that can assist qualifying war-time Veterans and their survivors. As our country’s Veteran and surviving spouse population grows older and ailments worsen, it’s important for Veterans and their families to know about the benefits available to them from VA.

VA pension is an income-based benefit offered to qualifying Veterans and their survivors. The amount of pension payable is based on the Veteran’s or survivor’s family income. VA may be able to deduct out-of-pocket medical expenses from income, including but not limited to amounts paid to nursing homes, assisted living facilities, and for in-home care. Additionally, if VA determines a Veteran or surviving spouse is housebound or requires the aid and attendance of another person, he or she may be entitled a higher rate of VA Pension.

Qualifications

  1. With some exceptions, the Veteran must have served on active duty:
  • Veterans who served on or before September 7, 1980 must have 90 continuous days of service with at least one of those days during wartime
  • Veterans who served after September 7, 1980, must have served at least 24 months or the full period they were called up
  1. Veterans must either be:
  • age 65 or older or
  • permanently and totally disabled

***VA assumes a Veteran to be permanently and totally disabled if the Veteran is a patient in a nursing home or found disabled by the Social Security Administration. There are no disability or age criteria for survivors.

  1. Veterans and surviving spouses must meet income and net worth criteria.

Applying

Though there are various ways to apply for VA pension, the fastest way to apply is online through https://www.ebenefits.va.gov/ebenefits/vonapp.

If you still have questions, a VA representative or Veterans service organization may be able to help. You can also comment below!