VA Requirement for Diagnosis Determination May be Hindering Gulf War Illness, Other Claims

The following Military Times article about a new Congressional look at VA's claims adjudications practices exposes one of the most likely issues -- hidden until now -- that have negatively affected so many ill Gulf War veterans from obtaining appropriate service-connected disability ratings.


Readers are encouraged to contact Congressional representatives to encourage written support for this Congressional initiative from U.S. Senate Committee on Veterans' Affairs Chair Patty Murray (D-Wash.).


--Anthony Hardie
Madison, Wis.

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Complex VA rules for doctors may delay claims

By Rick Maze - Staff writer, Military Times publications

A key lawmaker says the Veterans Affairs Department may be unnecessarily delaying disability claims by heaping needlessly complex requirements onto the physicians who screen veterans.

When a veteran has multiple health problems and multiple symptoms, doctors are required to determine what portion of a symptom is caused by which disability — a practice that “may not be medically supported and may be unnecessarily delaying the processing of some claims,” Sen. Patty Murray, D-Wash., the Senate Veterans’ Affairs Committee chairwoman, wrote in a Nov. 16 letter to VA.

VA spokesman Josh Taylor had no comment on the specifics in Murray’s letter.

“The department received the letter today and is reviewing it and will provide a formal response,” he said.

The agency currently has more than 868,000 pending claims, 61 percent of which are more than 125 days old.

Unnecessary requirements — such as pro-rating symptoms by disability for veterans with multiple issues — could be part of the reason for delays, Murray said.

“I have heard time and time again from veterans who are frustrated with having to wait months, years and even decades for resolution of their claims and appeals,” she said.

Murray became aware of the requirement to apportion symptoms to specific disabilities after a VA inspector general review of the department’s Seattle regional office — cited as a location with many claims errors.

“Medical providers are being asked whether they can differentiate what portion of the symptom is caused by each diagnosis and to provide an opinion as to which overlapping symptom is attributable to each disability,” Murray said. “In cases where a medical provider fails to address this question, regional offices are required to return examinations to the provider, delaying a final decision on the claim.”

The inspector general report disclosed delays when physicians failed to apportion claims in their initial examination, requiring the reports to be returned for further work.

Murray said VA could be asking the impossible.

“Based on staff discussions with VA physicians, it appears that a medical provider cannot scientifically, with a high degree of certainty, attribute an overlapping symptom to one disability or another,” she said. “If a provider cannot say with a level of certainty greater than 50 percent that a particular symptom is due to only one of the overlapping symptoms, it calls into question the practice of asking a medical professional to answer this question.”

In her letter to VA Secretary Eric Shinseki, Murray said if the procedure is not necessary to resolve the claim, maybe it should be dropped.

“Returning an examination for failure to address a question that is not supported by medical science delays the final resolution of a claim and unnecessarily contributes to the claims backlog,” she said.

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Source: Military Times, Retrieved online 11/26/2011 at http://www.airforcetimes.com/news/2011/11/military-complex-va-rules-may-delay-claims-111611w/