VA Wrongfully Denied 53 Million in Veterans Claims in 6 Month Period

In a recent six-month period, the VA’s office of Inspector General claimed that the VA left about 17,400 vets to pay out-of-pocket for emergency medical treatment that they should have covered. Between April 1 and September 30th 2017 veterans who got emergency care at non-VA facilities were forced to pay 53 million in medical bills they shouldn’t have been on the hook for.

Chairs of the house and senate veterans affairs committees sent a letter to the VA on Monday demanding answers. Rep. Chris Pappas who signed the letter states that “No veteran should be afraid to seek care in an emergency room.”

We understand that the claims process can be confusing; if you have any questions about your claims process Gumps V.A. Comp. Services would be more than happy to help answer them. Please give us a call at (888) 854 8677 or book an appointment with an accredited agent here.

What is a protected disability rating?

 A lot of veterans have questions about if the VA can reduce your disability. Short answer is yes, but there are ways in which you can be protected from any sort of a disability rating decrease. 

5-year rule

If your rating has been in effect for 5 years it can’t be reduced unless your condition has improved on a sustained basis and the VA has documentation supporting that you’ve improved permanently.

10-year rule

A service connected disability cannot be terminated if it has been in effect for 10 years. Compensation may be reduced if there’s evidence that the condition has improved. Of course there’s an exception to this if the VA can prove fraud. 

20-year rule

If your rating has been in effect for more than 20 years, it can’t be reduced below the lowest rating it’s held for the previous 20 years. Once again the exception is if the VA can prove fraud. 

What do these proteced ratings mean?

Let’s give an example, if you have a shoulder injury that gives you a 40% disability rating when you complete your VA evaluation, after 5 years, the VA can’t reduce this below 30% unless they prove the injury has healed on a sustained basis. After 10 years the benefit can no longer be terminated, and finally at 20 years, your VA disability rating cannot be reduced below a 40%.

We understand that the claims process can be confusing; if you have any questions about your claims process Gumps V.A. Comp. Services would be more than happy to help answer them. Please give us a call at (888) 854 8677 or book an appointment with an accredited agent here.

3 Biggest Mistakes Veterans Make When Filing VA Claims


Putting off the filing of your claim 

If you’re unsure if you’re eligible or waiting for your symptoms to subside, putting off a claim can cost you money every month. If you receive a decision down the road in a year or two, the benefits will be paid back to when the original claim was submitted. So get that claim submitted asap!

Sending medical records and not listing all of your symptoms 

When you’re sending medical records to process your claim for disability benefits, organization is key. We’ve heard of veterans sending 300 pages of medical records to the VA to process their claim for disability benefits and then have that claim denied only to resend the same medical records and complain about the inefficiency of the VA. Type up a 2 page summary in a binder with tabs to find important events. Much easier to process right? The goal is to make things as easy for the VA to process as possible. You’re helping the VA help you.

If you have lots of symptoms, instead of trying to only name your condition, list each symptom on your claim. The VA is obligated to follow up on potential conditions that would cause each symptom that you have and if multiple conditions are diagnosed you get a disability rating for each separate condition that will combine into a single overall rating.

Failing to pursue mental health claims 

Veterans may be hesitant to seek disability benefits for other mental health conditions. There are lots of mental health conditions that can come from military service like anxiety, amnesia, panic attacks, ptsd etc. Remember that mental conditions will be treated similarly to physical conditions. There are however conditions that aren’t related to military service due to the nature of the disorder like personality disorders, substance use disorders, and cognitive delays and developmental disorders. The VA rates mental health conditions are rated from a 0-100% scale based on the level of social and occupational impairment caused by the condition. For example a veteran may receive a 20% if symptoms are well controlled by a medication. Veterans with more serious symptoms who are unable to perform activities of daily living may receive a 100% disability rating.

We understand that the claims process can be confusing; if you have any questions about your claims process Gumps V.A. Comp. Services would be more than happy to help answer them. Please give us a call at (888) 854 8677 or book an appointment with an accredited agent here.

RAMP! Rapid Appeals Modernization Process

As you know, we have been very skeptical of the new RAMP program, but we are warming up to it. We had an opportunity to meet with Mr. David McLenachen, Director of Appeals Management Office for the Department Veterans Affairs. We had a frank conversation about the new RAMP program and discussed our concerns about the perceived risk involved with withdrawing a pending appeal as well as waiving certain due process rights in favor of opting into the new RAMP program.

One major concern was how withdrawing an appeal might have impact on the effective date of the case. After reviewing the new regulations as well as discussing various scenarios with Mr. McLenachen, we are confident that this risk is greatly minimized and potentially completely eliminated. The new process virtually protects the effective date through each of its possible avenues we might pursue an appeal. In fact, this protection actually is expanded to include a denial from the BVA as well as the CAVC. As long as new and relevant evidence is submitted within a year with a new selection of the next lane to pursue the benefit, the effective date of the claim remains intact.

We also had concerns about waiving some due process rights and such, but learned that there are protection in the new system that address this concern in a reasonable and fair manner. As such, for most of our cases, it appears that we can and probably should take advantage of the new process.

Benefits of the program outweigh the risk. Right now, the VA is rendering decisions in less than 120 days and granting nearly 60% of those that opt in. The possibility of getting an appeal favorably resolved in such a short time is quite appealing to us. So we are looking to opt in on as many of our appeals as we can, but we must do this strategically and carefully.  As more veterans “opt in” it is quite possible and reasonable to conclude that the grant rate will fall and the average days pending will increase.   However, we are mitigating this concern by performing development like obtaining independent medical and vocational opinions first to improve our cases likelihood of being favorable.

There are only certain types of cases that are eligible for opting into the program. For example, if you’ve recently received a rating decision, you may not opt in to the new appeals process. You would have to submit a Notice of Disagreement first under the old “legacy” appeal process, then you may opt in. This also applies to a recently denied appeal where a Statement of the Case was issued or cases where the appeal has been activated by the BVA for final disposition. In summary, only pending appeals eligible to opt in are those where a Notice of disagreement or VA Form 9 is pending review at the local level, which would include a BVA remanded case. One veteran may have several appeals at various levels, some which may be activated and not eligible, while others require that a notice of disagreement form or substantive appeal form (VA Form 9) must be filed first to be eligible. As such, we are reviewing each person’s appeal individually to opt in correctly to protect all the pertinent issues.

Another aspect that we must consider when opting into the new program is whether we have completed our development teeing up the case for the best possible outcome.  If you have an appeal pending and are considering this new program, it is often a good idea to secure medical and or vocational opinions to help strengthen your position. It is in our best interest to do this first before opting into the program.  If you would like our assistance and do not have an accredited agent or attorney currently assisting you, we encourage you to reach out to us so we can review your case and guide you through the process in a way that best benefits your interest.  After we’ve mapped out your case, we can refer your case to the appropriate experts to obtain the evidence we need to give you the best chance in a favorable outcome.

As of April 2, 2018, the VA is permitting anyone who wants to opt into the new RAMP to do so on their own. As such, we will be reviewing all our cases to begin working on this and taking advantage of it. If you feel that you could benefit from it and would like to know what we can do or are doing on your case, then please contact us!

Congress approves bill to address claims backlog

The veterans’ bill, approved by the Senate Aug. 1, is expected to reduce the time it takes for the Department of Veterans Affairs to handle appeals. The measure is part of an ongoing effort to reduce a longstanding claims backlog and is a priority for VA Secretary David Shulkin, who calls the appeals process “broken.”

On disability claims, the measure passed would overhaul the appeals process, allowing veterans to file “express” appeals if they waive their right to a hearing or the ability to submit new evidence. The VA could test the new program for up to 18 months until Shulkin could certify it was ready for a full rollout with enough money to manage appeals effectively. Lawmakers hope the legislation ultimately will reduce average wait times to less than a year.

In my opinion, this is nothing more than smoke and mirrors. Shuffling work around and calling it something different doesn’t speed anything up. The idea that a veteran should waive anything is ludicrous in order to convince the VA to grant compensation to a deserving disabled veteran.  Do you believe it’ll make a difference?

VA Removes Annual Income Reporting Requirement

The Department of Veterans Affairs (VA) is eliminating the annual requirement for most Veterans enrolled in VA’s health care system to report income information beginning in March 2014.  Instead, VA will automatically match income information obtained from the Internal Revenue Service and Social Security Administration.


Did you know? Over 1/3 of the VA backlog is claims based on Vietnam Service.

The Monday Morning Workload Reports, part of VA’s Transparency Program, are weekly compilations of performance measures for the processing of Disability, Pension and Education benefits, as reported by Veterans Benefits Administration (VBA) regional offices.

Aircrews Exposed to Agent Orange!

A growing amount of evidence supports the conclusion that veterans who served near aircraft used to spray Agent Orange
were exposed to Agent Orange. A scientific journal on Environmental Research titled “Post-Vietnam Military
Herbicide Exposures in UC-123 Agent Orange Spray Aircraft” concluded that trace levels of dioxin on such aircraft above the Department of Defense (DoD) standards of maximum permissible exposure to poisonous chemicals existed. Based upon surface wipes and airborne concentration test, the researchers concluded that
the crews would have inhaled, ingested, and absorbed through their skin the herbicide dioxin, commonly known as Agent Orange. Accordingly, in our opinion, any veteran who served on a crew that worked proximate to such aircraft should seek service connection for diseases identified as related to Agent Orange. For help in filing a claim, please contact us.