The House Subcommittee on Disability Assistance and Memorial Affairs Taps NVLSP Joint Executive Director Ronald Abrams to Testify on the Issue of Complex VA Disability Claims

The House Subcommittee on Disability Assistance and Memorial Affairs requested the expert opinion of NVLSP on the subject of adjudicating the Department of Veterans Affairs' most complex disability claims, in order to ensure quality, accuracy and consistency on complicated issues. NVLSP Joint Executive Director Ronald Abrams commented on the different types of complex claims and the factors that make a claim complex. Mr. Abrams also made a number of recommendations for policy changes which he believes would greatly improve the accuracy and efficiency of adjudicating these types of disability claims. 

Mr. Abrams testified that there are essentially three types of complex claims: first, there are claims which, by their very nature, are inherently complicated - these would include claims for entitlement to special monthly compensation (SMC), traumatic brain injury (TBI), the evaluation of joint conditions, service connection for PTSD (including claims for military sexual trauma (MST)), claims for secondary service connection, claims for service connection based on presumption, and claims for an increase in disability rating for a service connected back disability. Next, there are certain claims which have the capacity to become very complicated - for example, claims for direct and presumptive service connection, and claims that become complex as a result of VA errors (claims that are not properly adjudicated and prematurely denied).

Errors made at VA regional offices complicate claims, and among the most egregious of these errors is the premature adjudication of a claim without satisfying the VA statutory duty to assist the claimant by obtaining the evidence needed to substantiate the claim. Abrams noted that in many of these cases, the veteran would have to appeal to the Board of Veterans Appeals or the Court of Appeals for Veterans Claims. This could mean that due to VA error, a simple claim could take years to eventually resolve.

Another serious issue that Mr. Abrams raised during his testimony is the VA error rate for these complex claims. Currently, the rate of error is estimated to be between 30 - 40%, with the most common errors being premature denials, under evaluation of mental conditions, under evaluation of joint disabilities, failure to consider presumptive service connection, and failure to inform VA medical examiners what facts have been accepted as true by VA adjudicators. With an error rate as high as 30 - 40% for complex claims, it is unrealistic to assume that the accuracy rate at VA regional offices will ever reach its set goal of 98%.

Mr. Abrams offered a number of recommendations for addressing these serious issues. First, the VA should be required to submit to an independent quality review to validate the quality of work performed in the individual VA regional offices. Second, the pay grade levels of VA raters and Decision Review Officers should be raised on the condition that these employees are held accountable for the quality of their work. Third, Congress needs to continue to provide additional funding for more adjudicators. Fourth, adjudicating from electronic records is a laudable goal if complete records can be obtained and if the database permits logical searches. And finally, the adjudication culture at the VA regional offices needs to be changed. Many VA managers unfortunately act like they are producing widgets rather than adjudicating claims filed by real people. Their goal should not be just prompt adjudication; the goal should be a timely, accurate and fair adjudication - which in the long run is the fastest way to finally adjudicate claims. Abrams noted that the current VA management is trying to do this but stressed that more needs to be done.