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The VA Claims Backlog
If you can’t tell a pectoralis major from a latissimus dorsi, you may have trouble filing a claim.

Case files at a Veterans Affairs office in Winston-Salem, N.C.

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Say, for instance, a veteran suffered a leg wound and is unable to walk very well. He cannot simply file a claim for a bum leg. He can, however, file a claim for Disability 5311, which is classified under Disabilities of the Foot and Leg. The veteran must then provide evidence of injuries involving “Group XI, Function: Propulsion, plantar flexion of foot (1); stabilization of arch (2, 3); flexion of toes (4, 5); flexion of knee (6). Posterior and lateral crural muscles, and muscles of the calf: (1) Triceps surae (gastrocnemius and soleus); (2) tibialis posterior; (3) peroneus longus; (4) peroneus brevis; (5) flexor hallucis longus; (6) flexor digitorum longus; (7) popliteus; (8) plantaris.”

This is the necessary language for determining a medical disability. Anything less precise would lead to fraud and chaos. But ordinary war-fighters have no familiarity with this tribal language. It’s also important to understand that claims are not reviewed by doctors; reviews are largely conducted by mid-level GS federal employees. Compounding the problem is the fact that a “fully developed claim” must be named as such in the application, meaning the veteran must first know where and how to find the needed information, something VA is not very helpful in providing.

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Knowing where to locate this information and understanding it is only part of the challenge. The information must also be translated into the necessary language. The solution is to be examined by a physician. However, medical exams performed by or at the behest of VA do not normally occur until after the claim has been filed. With little knowledge of what information is needed, where to find it, and how to have it translated, hundreds of thousands of veterans are left in limbo. They often file incomplete or flawed claims, which may be denied for that reason and not because of the absence of a real disability. Others that are not denied can be mired in the backlog for months or years as the veteran tries to assemble the necessary evidence.

To VA’s credit, it has processed more than 4 million C&P claims in the past four years. But the data reflect a failure of imagination on the part of VA management, since this number falls nearly 500,000 short of the number of claims received. It’s not enough to tell veterans to “Visit VA-dot-gov” and file a C&P claim. The military should provide service members who are leaving active duty with a VA-oriented physical exam that pinpoints problems and describes them within the framework of the VA disability codes. This information could then be used by the veteran to file a better-developed claim.

There has been progress on this front. The Integrated Disability Evaluation System (IDES) was launched in 2007 and provides a means by which seriously wounded, ill, or injured service members can be more quickly moved into and processed through VA’s disability system. But it is used primarily for those leaving the service for medical reasons. For the vast majority of people mustering out of the military under ordinary circumstances, IDES does not apply. A simplified version of IDES that can be universally applied and provide separating service members with the basic technical information they need to begin the VA claims process would do much to close the veterans’ medical-information gap and get them on track to filing a fully developed claim.

Veterans who do not have the skill set to distinguish between a pectoralis major and a latissimus dorsi need a little hand-holding, and veteran service organizations like Disabled American Veterans, the American Legion, Paralyzed Veterans of America, and others offer free help to veterans navigating the VA claims process. They do it because they want to.

But this process is rightly the responsibility of the Department of Veterans Affairs, and VA should be more rigorous in helping veterans who enter the system after they shed their uniforms.

— Scott Hogenson is a Navy veteran and served as deputy assistant secretary for public affairs at the U.S. Department of Veterans Affairs from 2005 to 2007. 



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