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. <\/p>\n\n\n\n\n\n\n\n
Even though the VA has been aggressively working to resolve the\nsituation since 2013, many claimants still have to endure excessive wait times\n– several months or longer \u2013 for a new claim to be fully reviewed, and years\nfor a decision on an appeal. <\/p>\n\n\n\n
VA Claims<\/strong><\/p>\n\n\n\n A new VA\nclaim is an initial application for benefits like disability or pensions. After\nthe claim is filed, it goes through a multi-step review process, starting with a\npreliminary review by a Veterans service representative (VSR). The purpose of\nthis review is to determine if any additional documentation is needed to\ncomplete the case. <\/p>\n\n\n\n Most\nclaimants who apply directly to the VA without any help or assistance unknowingly\nsubmit incomplete claims. As a result, the VSRs end up having to contact the claimant,\nhealth care providers, and other government agencies in writing to collect the\nadditional evidence needed for review. This phase of the process. called claim\ndevelopment, can take many months and even years to complete.<\/p>\n\n\n\n Once\nthe additional data has been compiled, the case goes through a second review. If\nthe VSR determines that there is still insufficient evidence for an\nadjudication, the case is again put on hold while the information is collected.\n<\/p>\n\n\n\n Some\npeople can end up in a paperwork back and forth with the VA that goes on for\nages without a resolution.<\/p>\n\n\n\n New Claim Backlogs<\/strong><\/p>\n\n\n\n Pending claims in the VA system now average around 360,000. <\/p>\n\n\n\n The VA considers a new claim backlogged if no decision has been reached\non the case within 120 days (4 months). <\/p>\n\n\n\n In 2013, backlogged claims had reached an astounding 611,000 claims.\nVarious measures were undertaken to reduce the backlog, including mandatory\novertime and administrative changes. <\/p>\n\n\n\n Over the next few years, the VA began reporting that the backlogged had dropped\nto between 70,000 and 100,000 claims. However,\nIn September 2018, the Office of the Inspector General (OIG) discovered that the\nVA was only reporting 79% of the actual backlogged claims in the system.<\/p>\n\n\n\n Some of\nthe reasons for the continuing issues with backlogs include processing errors,\nprocessing system flaws, complexity of claims and, for disability claims, an\nincrease in the number of illnesses and diseases presumed to have been caused\nby Agent Orange, jet fuel and other toxic substances.<\/p>\n\n\n\n Backlogged Appeals<\/strong><\/p>\n\n\n\n If a\nnew claim is denied or there is a disagreement with the outcome, the veteran\n(spouse or dependent) can file a Notice of Disagreement. <\/p>\n\n\n\n Types\nof unfavorable decisions can include:<\/p>\n\n\n\n A\nNotice of Disagreement, which is the beginning stage of an appeal, can be submitted\nup to a year after the case has been adjudicated.<\/p>\n\n\n\n The\nnumber of backlogged appeals has been rapidly growing. Currently, there are an\nestimated 470,000 appeals cases in the system, with most taking 3 or more years\nto complete. <\/p>\n\n\n\n In a March\n2018 report issued by the Office of the Inspector General, it was determined\nthat the appeals backlog was the result of processing errors, priority given to\nnew claims vs. appeals, and significant periods of inactivity (up to 76% of the\ntotal processing time) when no work was being done on the claim. <\/p>\n\n\n\n The OIG\nalso discovered that:<\/p>\n\n\n\n More Changes Resulting in Backlogs<\/strong><\/p>\n\n\n\n Other recent factors that have contributed to the VA claim and appeals\nbacklogs include:<\/p>\n\n\n\n Getting an approval on a VA claim has always been difficult. In addition\nto meeting extensive eligibility qualifications and requirements, the claimant\nmust complete a complex, multi-page application and provide extensive\nsupporting documentation. Claim backlogs have made the process even more\ndaunting and arduous. <\/p>\n\n\n\n