Backlogged claims and appeals have been a long-standing problem for the Veterans Benefits Administration (VBA), the branch of the VA that provides financial and other forms of assistance to veterans, their spouses and dependents.
Even though the VA has been aggressively working to resolve the situation since 2013, many claimants still have to endure excessive wait times – several months or longer – for a new claim to be fully reviewed, and years for a decision on an appeal.
A new VA claim is an initial application for benefits like disability or pensions. After the claim is filed, it goes through a multi-step review process, starting with a preliminary review by a Veterans service representative (VSR). The purpose of this review is to determine if any additional documentation is needed to complete the case.
Most claimants who apply directly to the VA without any help or assistance unknowingly submit incomplete claims. As a result, the VSRs end up having to contact the claimant, health care providers, and other government agencies in writing to collect the additional evidence needed for review. This phase of the process. called claim development, can take many months and even years to complete.
Once the additional data has been compiled, the case goes through a second review. If the VSR determines that there is still insufficient evidence for an adjudication, the case is again put on hold while the information is collected.
Some people can end up in a paperwork back and forth with the VA that goes on for ages without a resolution.
New Claim Backlogs
Pending claims in the VA system now average around 360,000.
The VA considers a new claim backlogged if no decision has been reached on the case within 120 days (4 months).
In 2013, backlogged claims had reached an astounding 611,000 claims. Various measures were undertaken to reduce the backlog, including mandatory overtime and administrative changes.
Over the next few years, the VA began reporting that the backlogged had dropped to between 70,000 and 100,000 claims. However, In September 2018, the Office of the Inspector General (OIG) discovered that the VA was only reporting 79% of the actual backlogged claims in the system.
Some of the reasons for the continuing issues with backlogs include processing errors, processing system flaws, complexity of claims and, for disability claims, an increase in the number of illnesses and diseases presumed to have been caused by Agent Orange, jet fuel and other toxic substances.
If a new claim is denied or there is a disagreement with the outcome, the veteran (spouse or dependent) can file a Notice of Disagreement.
Types of unfavorable decisions can include:
- A determination that the claimant is not eligible for the benefit
- The veteran received a low disability rating (disability claims)
- The veteran or spouse received less than the maximum benefit amount (pensions).
A Notice of Disagreement, which is the beginning stage of an appeal, can be submitted up to a year after the case has been adjudicated.
The number of backlogged appeals has been rapidly growing. Currently, there are an estimated 470,000 appeals cases in the system, with most taking 3 or more years to complete.
In a March 2018 report issued by the Office of the Inspector General, it was determined that the appeals backlog was the result of processing errors, priority given to new claims vs. appeals, and significant periods of inactivity (up to 76% of the total processing time) when no work was being done on the claim.
The OIG also discovered that:
- 17% of all appeals were closed prematurely
- 13% of appeals were not processed in accordance with the Board’s instructions
- Only 29% of appeals cases resulted in a favorable decision for the appellant
- 7% of the appeals cases were closed due to death of the appellant
- In 68% of the cases closed due to death of the appellant, the appeals case had been pending for over a year.
More Changes Resulting in Backlogs
Other recent factors that have contributed to the VA claim and appeals backlogs include:
- The government shutdown from December 22, 2018 to January 25, 2019 – the longest shutdown in U.S. history.
- Asset rule changes in October 2018 included a 36-month look back on transfers & gifts and an automatic 3 Year IRS filing review on all new and existing claims as of 10/18/18
- In November of 2018, the VA introduced a new, longer benefit application form, a new Facility worksheet for care providers and institutions and a new “Income & Asset Statement in Support of Claim” form.
Getting an approval on a VA claim has always been difficult. In addition to meeting extensive eligibility qualifications and requirements, the claimant must complete a complex, multi-page application and provide extensive supporting documentation. Claim backlogs have made the process even more daunting and arduous.
Do you or a loved one need help paying for long-term care? Call us today at (877) 427-8065 to find out more about the VA’s Aid and Attendance benefit and how to navigate the system.