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What’s needed for processing a VA claim

First Posted: 9:47 am - July 17th, 2015

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A couple of questions Veterans Service Representatives (VSRs) are often asked about claims processing – “What is evidence?” and “Is my evidence helpful to my claim?” In short, evidence is anything you (the claimant) submit to VA, or VA attempts to obtain on your behalf, in support of your disability claim. According to Title 38 of the Code of Federal Regulations, evidence can be (but is not limited to):

• Military separation papers (such as DD 214, etc.)

• Separation Health Assessments or DoD’s Separation History and Physical Examinations.

• VA Disability Benefits Questionnaires (DBQs) which can be accessed, completed online, and downloaded at www.va.gov/vaforms/search_action.asp?FormNo=&tkey=dbq&Action=Search; Veterans Health Administration treatment records.

• Medical records from private providers.

• “Buddy statements” – statements from fellow Veterans you served with, family members or friends who can support your claim.

Sometimes, VA requests very specific evidence. In those instances, they will indicate exactly what they are looking for. However, if you file at https://www.ebenefits.va.gov/ebenefits/homepage a Fully Developed Claim through eBenefits, that is your way of telling VA that you have uploaded all the appropriate evidence necessary to support your claim and have no intention to submit additional evidence.

Is the evidence helpful to your claim? If you’re thinking of sending VA evidence to support your claim, you are encouraged to ask yourself, “Does this evidence directly support my claim?” Evidence that most closely relates to the issue or issues you are claiming will help VA process your claim more quickly and accurately. If you’re still unsure, a VA representative or a Veterans Service Organization may be able to help. At https://www.ebenefits.va.gov/ebenefits/contact is information to assist you in contacting a VSR in person, online, or by phone.

At https://www.ebenefits.va.gov/ebenefits/manage/representative you can locate and/or request for an attorney, claims agent, or Veteran Service Organization (VSO) to help prepare and submit your claims for VA benefits. Have a question about what “evidence” you should submit? Submit it at www.blogs.va.gov/VAntage/20982/what-va-means-by-evidence-when-processing-claims. (Source: VAntage Point Blog | Mark P. Ledesma | June 24, 2015)

Wait lists grow

One year after outrage about long waiting lists for health care shook the Department of Veterans Affairs, the agency is facing a new crisis: The number of veterans on waiting lists of one month or more is now 50 percent higher than it was during the height of last year’s problems, department officials say. The department is also facing a nearly $3 billion budget shortfall, which could affect care for many veterans.

The agency is considering furloughs, hiring freezes and other significant moves to reduce the gap. A proposal to address a shortage of funds for one drug — a new, more effective but more costly hepatitis C treatment — by possibly rationing new treatments among veterans and excluding certain patients who have advanced terminal diseases or suffer from a “persistent vegetative state or advanced dementia” is stirring bitter debate inside the department.

Agency officials expect to petition Congress this week to allow them to shift money into programs running short of cash. But that may place them at odds with Republican lawmakers who object to removing funds from a new program intended to allow certain veterans on waiting lists and in rural areas to choose taxpayer-paid care from private doctors outside the department’s health system.

Since the waiting-list scandal broke last year, the department has broadly expanded access to care. Its doctors and nurses have handled 2.7 million more appointments than in any previous year, while authorizing 900,000 additional patients to see outside physicians.

According to internal department budget documents obtained by The New York Times, physician workloads — as measured by an internal metric known as “relative value units” — grew by 21 percent at hospitals and clinics in the region that includes Alabama, Georgia and South Carolina; by 20 percent in the Southern California and southern Nevada regions; and by 18 percent in North Carolina and Virginia. And by the same measure, physician care purchased for patients treated outside the department grew by 50 percent in the region encompassing Pennsylvania and by 36 percent in the region that includes Michigan and Indiana.

The largest driver of costs has been programs designed to send patients to outside doctors, either because of delays seeing V.A. clinicians or because patients need treatments outside the system. Other major factors include the demand for new prosthetic limbs and for the new hepatitis C treatment.

Last year’s waiting-list crisis led to complaints that the department was divided by an acrimonious and retaliatory culture, where whistle-blowers were punished and constructive criticism was stifled. But many experts say the principal problems were a shortage of doctors and nurses in the system, the nation’s largest integrated health care organization, and a lack of office space for patient care — while demand rose sharply from aging Vietnam War veterans and service members from Iraq and Afghanistan.

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