VA to Roll Out New Claims Appeals Process This Week

Randy Reynolds, a veteran service representative with the Oklahoma Department of Veterans Affairs Claims and Benefits Division, speaks with a veteran. (Air Force/Kelly White)
Randy Reynolds, a veteran service representative with the Oklahoma Department of Veterans Affairs Claims and Benefits Division, speaks with a veteran. (Air Force/Kelly White)

In what Department of Veterans Affairs officials are calling the biggest change to its appeals process in decades, the department will launch a new system this week for veterans challenging their disability claims decisions.

The new process gives veterans three options for contesting their claims, with an eye toward drastically reducing the time it takes to receive a final decision.

At the height of the VA appeals backlog in 2013, some veterans had waited years for a decision and more than 610,000 claims sat unadjudicated. To tackle the backlog -- defined as cases that weren't decided within 125 days -- the VA hired new employees, instituted mandatory overtime and introduced new processing systems.

Still, the problem persisted with an average wait time for a decision reaching up to three years and the number of backlogged appeals climbing to roughly 300,000 by 2017, when Congress passed the Appeals Modernization Act, or AMA.

Under the AMA, veterans will have three choices if they want to appeal the decision on their disability compensation or other VA claim.

The first option is the "supplemental claim lane," in which they can introduce new evidence in their case and have a regional specialist review it and make a decision.

Or they can choose the "higher-level review lane," in which they request that their case be reviewed by a senior adjudicator rather than the regional office. This review will consist largely of looking for errors or mistakes made in interpreting VA policies or laws governing the claim. If a problem is found, the senior claims adjudicator can require that a correction be made.

And finally, they can appeal the decision to the Board of Veterans' Appeals -- basically the same as the current system, although there will be several paths to consider if they request a board review. These paths include:

  • A direct review, in which they don't submit any additional information and waive their right for a hearing;
  • Submission of extra evidence without a hearing;
  • Or a full hearing, in which they can submit more evidence and testify before a judge.

When veterans receive their initial claims decision, they also will get a letter explaining the reasoning for it, as well as the appeal options "in clear language," said Cheryl Mason, chairwoman of the VA's Board of Veterans Appeals.

"What the AMA was built and designed to do was create a simplified process for veterans. ... [Officials] realized that veterans were confused by the process; it was a complex system and it simply took too long," she said.

The new system will be used throughout the VA for any claim that requires a decision, according to Dave McLenachen, director of the Veterans Benefits Administration appeals management office.

This includes education and insurance decisions, vocational rehabilitation and caregiver benefits applications, he said.

VA leaders hope that the new system will reduce the time it takes for veterans to receive a decision on their appeal to 125 days.

Currently, the VA's claims backlog is 265,000 cases, while an additional 136,000 cases are under review by the Veterans Board of Appeals, for a total of more than 400,000 cases. VA officials said Thursday that the goal is to clear the backlog by 2020.

A pilot version of the new system, called the Rapid Appeals Modernization Program, or RAMP, was introduced shortly after the AMA was signed. According to McLenachen, more than 70,000 veterans with 84,000 claims appealed through RAMP. The VA has adjudicated 70 percent of those appeals, awarding about $250 million in retroactive benefits, he added.

RAMP will stop accepting new appeals on Friday. Veterans whose claims were filed through RAMP will continue to be processed.

Veterans whose claims are currently in the system and who don't apply for a decision through RAMP by Friday can opt into the new system if they receive a statement of case from the VA or supply supplemental evidence and receive a supplemental statement from the VA.

Legislators and veterans service organizations helped craft the new system and have largely been supportive of it, although some have voiced concerns over legacy claims and the information technology infrastructure needed to support the new program.

VA officials said they are ready, having hired 605 new employees to handle the appeals.

Mason called the new system a "veteran-friendly change."

"It gives veterans a choice and control over their process instead of getting stuck in the legacy system for three to seven years, on average," she said.

-- Patricia Kime can be reached at patricia.kime@military.com. Follow her on Twitter @patriciakime.

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