On April 19, 2013, the Department of Veterans Affairs (VA) announced it is implementing an initiative to expedite disability compensation claims that are over one year old. VA claims raters will make provisional decisions on the oldest claims in inventory, as well as order and expedite any medical examinations necessary to decide claims.
There’s a key phrase in this opening paragraph: “provisional decision.” A provisional decision is essentially a “placeholder decision” – a decision qualifies if the VA can make the determination that a veteran is entitled to at least a minimum rating. Before it assigns this minimum rating, however, it may be necessary for the VA to provide an expedited medical examination.
The best way to demonstrate how this works is to provide an example. Let’s say a veteran submitted a claim to a Regional Office (RO) in 2011 for traumatic brain injury (TBI). The evidence submitted shows that the veteran shows symptoms of TBI, but a neurological examination is necessary to rate the disability. The RO has not yet scheduled an examination.
Under the new initiative, here’s what will happen. First, since a VA examination is necessary, that examination will be ordered and expedited. The RO will issue a provisional decision. Then, for up to a year after the provisional decision is issued, the veteran will also have the opportunity to submit additional evidence. If he does, and the RO finds that an increase in rating is warranted, that increase will be backdated to the date the initial claim was filed. If the veteran does not submit additional evidence, the provisional decision becomes final one year after it is issued.
So here’s the breakdown:
- The VA will pull claims that have been pending for over a year, to be expedited.
- If an exam is necessary to decide the claim, it will be ordered and expedited.
- VA RO claims adjustors will make “provisional decisions” on these claims.
- The veteran will have one year after the date of the provisional decision to submit additional evidence. If any increase is determined to be warranted based on the additional evidence received, benefits will be retroactive to the date the claim was filed.
- If no additional evidence is received within a year, the provisional decision will become final.
- First, how long will it take for provisional decisions to be rendered? In other words, what does “expedited” mean? How long is it going to take the VA to pull the claims that have been pending for over a year? (And if these are some of the oldest claims, shouldn’t they be close to the front of the queue already?)
- Second, is this process limited to initial claims that have not yet been assigned a rating, or does it apply to decisions for which veterans have already issued Notice of Disagreements (NODs)? As many veterans who have been through that process know, it can take years for VA movement after a NOD.
- Third, how much will this slow the disability compensation claims process generally? This new initiative adds several new steps, including identifying and pulling those claims that must be fast-tracked, and sending letters to those veterans whose provisional claims have become final after a year. As noted in a VA press release, “the focus on processing the oldest claims will cause the overall measure of the average length of time to complete a claim – currently 286 days – to skew, rising significantly in the near term because of the number of old claims that will be completed.” The VA contends that once the backlog is cleared and more claims are processed electronically, the processing time will decrease significantly, but it has not provided a time frame for this.
These will remain questions until the initiative is implemented. Stay tuned in the months to follow for the answers. In the meantime, access the VA’s news release on the initiative here and the VA fact sheet here.
Did you find this article informative? If so, sign up for my weekly blog on veteran-related matters here.