Jim,

I really appreciate what you do with this sight. I am very thankful for your answers. My question is how can VA make a decision on a denial claim within a month. But it takes two years to make a deciion on your claim. Thanks

Reply:

There are 2 people in the decision chain of command who are instrumental to your claim. There are many others who work around them but these 2 control the process. These are VA employees. Who is or isn't an employee of the federal Department of Veterans Affairs can be confusing. Any time you think about how the process works, be sure you know exactly who you're talking about.

The Veterans Service Representative (VSR) is responsible for gathering all the data required to make a claim decision. This process of organizing the information is often referred to as perfecting the claim folder or file. The VSR has a glance at the claim and begins to retrieve medical records, schedule C & P appointments and so on. Once the folder is perfected, it gets in a long line and waits to be reviewed by the Ratings Veterans Service Representative (RVSR).

The RVSR is the person who makes a decision on awarding a benefit or denying it. The RVSR works on a quota. He or she must completely close (x) number of files each day to meet the assigned quota. The way the quota is determined is complex. Some claims may count for extra points if they are complex and so on.

If the RVSR makes the quota each month there is a performance bonus that is added to their paycheck.

Of course, this is a terrible idea on the surface of it all. To set a quota is generally regarded as a bad idea in most industries...tying it to a performance bonus makes it worse.

The real problem comes when we realize that the work product of the RVSR isn't checked for quality. Only a few of the RVSR's decisions are ever looked at by a supervisor or a higher up manager. Even then, only awards that give substantial money to the veteran are checked. The VA is interested in trying to find ways to not pay you money.

This means that the claims that are denied go without any scrutiny at all. You're probably beginning to see the problem by now. If the RVSR has some tough cases to look through and needs to make that quota so he/she can get the bonus, the easy way to do that is to deny a few folders quickly and get on with business. The RVSR can scan a few folders and find anything at all that looks easy to deny...and then deny it. It doesn't matter if it's a good decision or a bad decision, the only person who will care is the veteran.

By the time the veteran gets a denial letter and then decides what to do about it can take months. Many vets get a denial letter and instantly give up without any appeal.

To receive a denial letter a month after filing, as you mention, is unusual. Most denial letters take about the same time that a well done award letter does. However, I can see where a quick and easy denial could happen if the demand for meeting a quota was a high priority.

The process is badly broken. Everyone but the RVSR agrees the quota system is the wrong way to do business. Typical of VA, everyone talks about it...nothing substantial is done.