Tag Archives: VA

Behind the curtain: The VA Claims Process

Posted by Mike Grice on

In my last post I wrote about my experience with the Veterans Administration during my physical exam process.  It took a few months to get through the paperwork and and to actually see doctor or two, and now I am waiting for the results.  And I am now in month three of waiting…

So why does it take so long?  Sure, there are zillions of us new veterans entering the system, but there must be a method to their madness.  After doing a little research, I found out that there is indeed such a method and that is what this post is about: the VA Claims Process.

My faithful readers have already seen the first part of the process in previous posts, but to make sure nobody gets left behind I will recap my adventures up to this point for those who are just joining the party:

The purpose of the VA medical evaluations and claims process is to document any injuries or physical issues that were caused or exacerbated by military service.  The evaluation is important for two specific reasons; first, if a servicemember is injured while on active duty it is important for that injury to be documented in case it requires treatment after they get out of the military and second, in cases where the servicemember has incurred chronic conditions or disabling injuries they are eligible for financial compensation.

If a veteran breaks his ankle while on active duty, for example, and gets out while while he is still going through physical therapy he isn’t out of luck.  His injury still requires treatment, so it is annotated during the physical exam and he will be able to use the VA medical system to get through the necessary physical therapy and get back on his feet.  Once he is better he goes on his way and he may never need the VA again.  However, since the VA evaluated his ankle and documented the injury, in case the veteran needs future treatment he is in the system and can still have that service-related injury treated by the VA in the future.  Taking the example further, if the veteran with the broken ankle is left with a limp for the rest of his life he will likely be evaluated as having incurred a disability.  Depending on the rating that the disability is assigned (I will devote an entire future post to disability assessment and ratings- don’t worry!) he may be eligible for a small disability check every month.

So being evaluated by the VA is important!

Back to my case.

I started my VA evaluation process as soon as I went on terminal leave, and before my EAS I had completed all of my physicals.  As I posted earlier, however, I slowed down the evaluation and claims process because I submitted the incorrect DD-214, which was caught by the case manager and rectified after I sent in the correct copy.  Although it seemed a bit random to me, there actually is a pretty well defined process that claims go through, which shouldn’t have surprised me because after all the VA is a governmental agency that runs on thoroughly bureaucratic processes.

Here is a breakdown of just what those claims processes are, starting from when my claim was initiated in my first meeting with the VA representative after going on terminal leave:

“Claim Received” – Your claim has been received by the VA. If you applied online with VONAPP (Veterans On Line Application – the web based application for VA benefits) Direct Connect, you should see receipt in your list of Open Claims below within one hour. If you applied through the U.S. mail, please allow mailing time plus one week for us to process and record receipt of your claim.  (Note – the process steps and descriptions are from the VA website)

“Under Review” – Your claim has been assigned to a Veterans Service Representative and is being reviewed to determine if additional evidence is needed. If we do not need any additional information, your claim will move directly to the Preparation for Decision phase.

It is during this phase that my errant paperwork was discovered.  It took about a month, but the system works because the claims representative discovered that I had submitted the incorrect paperwork and notified me.  It cost me a little time, but once I sent in the right documentation, my claim continued along to the next step.

“Gathering of Evidence” – The Veterans Service Representative will request evidence from the required sources. Requests for evidence may be made of you, a medical professional, a government agency, or another authority. It is common for claims to return to this phase, should additional evidence be required.

“Review of Evidence” – We have received all needed evidence. If, upon review, it is determined that more evidence is required, the claim will be sent back to the Gathering of Evidence phase.

I was contacted during this phase to provide a more detailed description of how I incurred an injury while in Iraq.  Again, the system works because the VA identified, through their due diligence, that I did not have enough documentation to support a portion of my claim.  So I filled out the form and described the situation in greater detail, and with receipt of the completed form my claim moved further along the path to completion.

“Preparing for Decision” – The Veterans Service Representative has recommended a decision, and is preparing required documents detailing that decision. If more evidence is required, the claim will be sent back in the process for more information or evidence.

This is where my case currently sits.  It has been there for a couple of months.  I did receive a letter last week from the VA apologizing for the delay in processing, so I know that my file isn’t lost behind a filing cabinet or being used as a doorstop.  I do appreciate that they took the time to let me know that they were just behind schedule and that they were still working on my case.

“Pending Decision Approval” – The recommended decision is reviewed, and a final award approval is made. If it is determined that more evidence or information is required, the claim will be sent back in the process for more information or evidence.

“Preparation for Notification” – Your entire claim decision packet is prepared for mailing.

“Complete” – The VA has sent a decision packet to you by U.S. mail. The packet includes details of the decision or award. Please allow standard mailing time for your packet to arrive before contacting the call center.

So I have three steps to go, and hopefully it won’t take too long!  The good news is that I am eligible for VA healthcare because I am a veteran regardless of when they complete my package.  Having it done will be helpful, however, because then all of my information will be in the system.  It will also be good to know if any of the mileage that comes with a 27 year career in the Marines results in a disability rating…

__________

Lessons Learned:

1.  It takes time.  A lot of time.  I have been working through the process for six months, with the clock starting with my first VA appointment.  It is important to meet with the VA as promptly as possible once you have your DD-214 in your possession because the process is so lengthy.  You procrastinate at your own peril…as I wrote about in a previous post, if you can get your case initiated within 60 days before your EAS you will have your case reviewed by the locally by the VA instead of having it sent to their main evaluation center.  The anecdotal difference is about eight months- I was informed that it should take about four months after all of your information is provided for a local review as opposed to a year or so for a national level review.  It pays to be prompt!

2.  Get all of your ducks in a row before you initiate your package.  Missing or incorrect paperwork will stymie you progress, so avoid having the VA go through the nutroll of contacting you to update the package.  In my case, I provided the incorrect DD-214 and had to provide greater detail about an injury, and both of those transactions took time.  I recommend that when you fill out the pre-appointment paperwork that you go into excruciating detail in regards to any injuries that you suffered. The few extra minutes that you take filling out the form may save you the loss of a month in processing time later.

Final Physical exam finally finished!

Posted by Mike Grice on

I left you, my constant reader, pensively hanging after my last post about my Veterans Administration physical.  How did everything turn out, you wonder?  Well, I am still wondering how it all turns out too.

The VA has become a very busy governmental agency during the last few years.  The wars in Iraq and Afghanistan have spurred the dynamic growth of all of the armed services, and now as combat in Iraq has ended and Afghanistan winds down there are many thousands and thousands of new veterans leaving the service.  The burgeoning numbers are compounded by the government’s budget deficit and military belt tightening as the growth that the Army, Navy, Air Force, Coast Guard, and Marines experienced in the latter part of the last decade retrenches and the population of the armed forces shrinks back to pre-war levels or lower.  Add all of us new veterans to those from World War II, Korea, Vietnam, Desert Storm and the Cold War and pretty soon you have a pretty huge population of veterans for the VA to oversee.

At any rate, the meteoric rise in the VA population has slowed some things down, and one of those things is the completion of the disability rating evaluation.  The disability evaluation is performed by the VA to document and, if required, compensate veterans for physical or mental conditions that were caused or aggravated by their military service.  The process is a pretty fair one but it requires the veteran to put some effort into ensuring that all of the documentation is in their record and that they attend all of the required appointments.

In my case, I initiated the process right after I checked out of the Marine Corps and started my terminal leave.  On that day I turned in all of my required files (including my original medical and dental records) and received my orders back to civilian life as well as two versions of my DD-214, known as “Member 1” and “Member 4”.  With these documents in my hands I then went to the Veterans Affairs office on base and made a walk-in appointment to see what to do next.

After waiting about a half hour to see a counselor, I went in and professed my utter ignorance of what to do and laid myself before the mercy of the VA.  Fortunately, the lady who took my case had seen plenty of knuckleheads like me before and she professionally ran me through the requirements.

“Do you have your DD-214?”

I handed it over.  Well, actually I handed her a copy.  The original is probably the most important document you will receive during your transition because it is the only universally recognized form of proof that you served in the military, and it is your ticket to the dance that is the VA.  As an aside, when you check out make sure to ask for a half dozen or so “Certified True Copies” of your form because some agencies will not accept a FAX or photocopy.  The admin shop will make copies and stamp them as certified, which will come in handy later.  Trust me.

“Do you have your medical record?”

I patted the thick folder on my lap.

“Have you been pre-screened?”

I explained that my record had been evaluated by the Disabled American Veterans counselors during my Transition Assistance Class, and I showed her the form that they filled out.

“When do you EAS?”

I told her that my last day was New Year’s Eve, and she paused.  In a speech that she had obviously given hundreds of times before she explained how the timeline for VA claims works.  It is important to file at the right time, she said, because depending on when a vet files has a tremendous impact on how quickly the case will be evaluated.  Based on your EAS if you file too early, your package gets sent off to a regional evaluation center and it may take up to a year to get evaluated.  In my case, since I was three months from my EAS I fell into the “too early” category.  If you file too late your package gets sent off to the same place and it will likely take a year.  Too late is defined as after your EAS.  She explained that if you submit your claim 60 days or less before your EAS then your case will be evaluated by the local VA office, and that the turnaround rate is about four months.

My choice.

She smiled at me across the desk and sweetly inquired if I would like to submit my claim today or if I would like to submit it in a month or so….

A month later I was sitting across the same desk from the same nice lady.  Since I was now in the “sweet spot” of claim submission I presented her with all of my information and got started.

Here is what she needed to get initiate the claim:

1.)  Photocopy of my medical and dental record.  These accompany your claim during the evaluation, and you will eventually get these back.

2.)  Copy of the pre-screening checklist that was performed at the Transition Assistance Class.

3.)  Copy of your DD-214.  Not just any copy, mind you, but the “Member 4” copy.  Why do I know this?  Because I submitted the wrong one, of course, and had to resubmit the correct one a month later (which slowed down my claim).

With the thick packet in front of her she began making some phone calls.  Although I had completed my military physicals I now had to have my VA evaluations completed.  After ten minutes or so of coordinating dates and times, she handed me three appointment reminders for the three evaluations that I would need to complete in order for my case to be adjudicated.

These three appointments were totally on me.  I was required not just to show up, but to complete the pre-appointment paperwork, which was basically a questionnaire that asked about each and every item that I had identified as a malady or injury that was incurred during my service.  Things like a dislocated shoulder (When did it happen? How?) to a broken ankle (what treatment did you receive?  Any surgery?).  The paperwork was a little daunting, but without it your claim will not see the light of day.

Anyhow, I made it through all three appointments, and by the time my EAS came and went my claim was wending itself through the local VA office.  It has been about four months now, and I have been eager to see what the result will be….

…and yesterday I got a letter in the mail from the VA.  Wow, I thought, she was right!  Less than four months and I got my results.  Sweet!  Smugly I opened the letter.

Not so smugly I read what it said.  “Dear Michael,”  it read, “we are sorry to inform you that your case is still under review….”  D’oh.  It looks like I still have a month to go, but that’s OK.  The good thing about being retired is that time is not necessarily one of my problems.  I can wait.

__________

Lessons Learned:

1.)  Talk to a VA counselor as soon as you can.  Make an appointment while you are still on active duty if you can, because even if they can’t help you until you go on terminal leave they can explain the processes and procedures that you will need to follow to obtain evaluations and benefits.

2.)  Schedule a meeting immediately after going on terminal leave.  You can officially start your evaluations and benefits requests when you have your DD-214 and final orders.  It really behooves you to start as early as you can because the VA is a bit overwhelmed with the huge number of new veterans applying for benefits.  If you wait all you do is compound the problem.  It is a first in, first out system that is irrespective of military rank or position.  Don’t think that your uniformed high ranking muckety-muck status means anything to the VA because it doesn’t.

3.)  Get as many “certified true copies” of your DD-214 as possible.  I have had to give out several so far, and it is easy to get them when you check out.  Much less easy later, trust me.

4.)  Make sure to provide the correct documentation to the VA.  It cost me a month because I submitted a “Member 1” vice a “Member 4” DD-214 with my claim.  What’s the difference?  As far as I can tell there is one additional block of information on the “Member 4” version.  Apparently it is a pretty important block!

Final Physical Exam….or not. Welcome to the VA!

Posted by Mike Grice on

My last post was about the Veterans Administration, and not long before that I wrote a string of posts about what I thought were my last and final physical examinations.  Oddly, I soon found out that the VA and physical examinations are inextricably linked.

Just like peanut butter goes with chocolate and peas like carrots the Veterans Administration and physical examinations go together too.  It turns out that I was right about my Final Physical Examination being the last one that I would go through in uniform, but what I didn’t realize was that it would be immediately followed by my first physical examination by the VA.

The VA, among a host of other things, is responsible for determining whether or not you are eligible for a disability rating (and compensation) for any injuries or conditions that you suffer as a result of your service.  The military’s final physical is just your last checkup on the way out the door; the VA physical is your first checkup on the way into civilian life.  In addition to finding out if you are disabled in any way the VA makes sure that you don’t have any conditions that require additional treatment once you take off the uniform.

There are plenty of examples of both disability related conditions and continuing treatment requirements; for example a disability may range from losing a limb or an eye in combat to tinnitus caused by the roar and whine of aircraft engines, while physical therapy to help recover from knee surgery is a case in point for continued medical treatment.  At any rate, the VA is responsible for caring for the veteran, and in order to determine what type of care a vet requires they need to have their doctors take a look under the hood (or hospital gown, as it were).

As my active duty days drew to a close I had finished all of my required checkups and paperwork to head out to the civilian world.  On my last day in uniform I received my official orders back to my civilian life, and with a handshake and a “see ya later” I set out on terminal leave and prepared for life back on civvy street.  One of my first stops (after recovering from the retirement party hangover) was to the VA office, where I dropped off my DD-214 (the most important document for a veteran – it is your key to benefits and it is the official proof that you served in the military) and began the process of becoming a “customer” of the VA.

Along with my DD-214 I handed over a copy of my medical record (make sure to make an extra copy- this is VERY important, because you turn the original in when you check out on your last day in uniform, and the VA needs a copy to evaluate you for a disability rating and other medical concerns), and the nice lady in the office asked me a few questions.  She then took a quick look at my records and started making some calls.  Within a few minutes she had set me up with three appointments at a contracted medical office that the VA uses to evaluate separating veterans.  She said that I would be receiving some information in the mail, and that it was now on me to ensure that I did everything necessary to complete the evaluation process.  She also said that it could take anywhere from four months (in the best of all possible worlds) to a year or longer (which is not unusual) for my case to be evaluated and any disability rating to be issued.  If I didn’t do what I was supposed to do it could take literally forever, because although the VA is there to help veterans they are not there to hold your hand and drag you through the process.  That’s up to you.

Anyhow, I left the VA office with a few appointments and the pleasant, though pointed, reminder that it was up to me now.  In order to take advantage of all of the great medical benefits that I had earned and to see if I had a disability rating I would need to take the initiative to attend appointments without anybody besides myself reminding me.  There would be no Drill Instructors to tell me what to do next.  Welcome back to the real world.

__________

Lessons Learned:

1.  Make at least one copy (two if you can) of your complete medical and dental records.  Your separations office on base should let you use the copier to make copies, and if they don’t, you can use the copier at the career counseling center.  If you don’t want to stand over a copier for hours fighting paper jams and toner outages, you can take it out in town to a Kinko’s or other copier business- it will cost a few bucks, but time is money.  Your original record will be turned in to get your orders home, and the VA needs another copy to evaluate.  Remember this:  the VA and the DOD are separate governmental agencies and if you think that they will coordinate your transition for you then you need to take another urinalysis test.

2.  Make sure that you leave the VA office with appointments for physical evaluations.  Your claim for medical benefits will not start until the evaluations are complete, so if you blow off or forget an appointment your case will just languish on some desk somewhere until it crumbles into dust.  If you want benefits, then you need to do the legwork to make sure the process moves along.

From Marine to Veteran

Posted by Mike Grice on

On January 1st of 2012 I officially made the big step out of my combat boots and into my flip flops.  It was indeed a significant and personal event, but it also marked a pretty significant change in my status in the eyes of the federal government.

On that day I became a non-member of the Department of Defense and the newest constituent of the Department of Veterans Affairs.  This jump is significant for a lot more reasons than I realized, and it can be confusing and overwhelming if you aren’t ready for it.

The day you become a civilian again marks the day you can no longer take advantage of many of the benefits you enjoyed in uniform.  If you are moving on after an enlistment or two and are not joining the retired rolls, then pretty much all of the benefits disappear with your short haircut.  No more tax free shopping at the Post Exchange and no more subsidized groceries at the commissary –  you are fully back in the civilian world and get to pay full price (tax included!) for your next pair of cargo shorts.

If you are retiring, however, you are still entitled to some benefits.  You can still shop at the PX and the  commissary, which is nice.  You can take advantage of many of the recreational facilities, too, such as the campgrounds, gymnasiums, and beach cottages.  Your priority slips to one peg below those still on active duty, but that’s ok.   After all, you’re retired now, so you have all the time in the world…or not, but that’s another story we’ll talk about later.

Either way, whether you are retired or simply out of the service, you still have a governmental agency that is looking out for you.

Enter the VA.

So what exactly does the VA do for you?  Well, let me fill you in.  First, a little bit of history.

The Veterans Administration’s lineage stretches back all the way to the Revolutionary War, when the Continental Congress made provisions for pension payments to soldiers who were disabled as a result of their service.  Over the next hundred years or so, the benefits and provisions grew with the nation’s involvement is wars at home and abroad, with the most significant being the war between the states.  Recognizing the sacrifice of those in uniform, none other than Abraham Lincoln said of the importance of the government’s duty to the veteran:

“To care for him who shall have borne the battle and for his widow and his orphan…”

By the beginning of the 20th century there were many programs to help veterans.  There were veteran’s retirement homes as well as hospitals and other facilities, with the responsibility for taking care of vets shared between several federal agencies as well as the individual states.  With the carnage of the First World War, however, it became evident that a consolidated and coordinated federal system was needed to meet the demands of the many thousands of veterans and their families.

In 1930 the Veterans Administration was created by act of Congress.  It consolidated all of the federal programs and responsibilities under one cabinet level department and took the onus of care off the backs of the individual states.  With the Second World War the department expanded dramatically and became the VA as we know it today.

So what can the VA do for you?  Here is a quick list of some of their major programs:

-Home loans

-Educational benefits

-Life insurance

-Special adaptive housing benefits for wounded servicemembers

-Medical care

-Psychological care

Within those major programs are dozens and dozens of smaller ones.  Take, for example, the educational benefits.  It isn’t just for college!  There are programs to teach you trades and skills completely free of charge, and depending on your status you may even be paid a housing allowance to go to school.

So when you take off your uniform for the last time don’t forget that there is an entire government agency that still has you in mind, and there are a lot of programs that can help you as you explore what is next in your life.  The educational benefits and home loan eligibility don’t disappear on your last day of service, and depending on your disability evaluation or retirement status you may be entitled to free health care as well.  Make sure to talk to someone at the VA during your transition journey.  I guarantee you will be surprised at how much they can do for you!

__________

Lessons Learned:

1.  Once you hit your EAS date you no longer fall under the DOD, but instead under the VA.  This is a big deal because you can’t go back once you transition over.  I will cover more about how important this is in future posts.

2.  The benefits are astounding in many cases, but it is up to you to seek them out.  Nobody is going to come to your house and educate you on the various programs.  Go to http://www.va.gov/ and look around.  You’ll be pleasantly surprised at just what the Veterans Administration offers.