Complex Veterans Benefits Cases Require Common Sense Approach

Veterans with complex medical conditions, whose lives don't fit neatly into pre-determined templates, are often needlessly denied life-critical benefits because the Department of Veterans Affairs (VA) relies far too heavily on disability checklists and rules-based calculators.

Complex medical cases demand human reasoning and judgment to achieve true accuracy. Strict adherence to rules-based algorithms and checklists has already left too many veterans shortchanged in their benefits.

Those of us at Paralyzed Veterans of America (Paralyzed Veterans) appreciate the need for speed in rating disability claims to expedite the delivery compensation and other benefits to veterans, and recognize that VA is focused on addressing the backlog in veterans' claims.

Paralyzed Veterans embraces the notion that there must be a balance between modernized processes, standardization, expertise and common sense when evaluating the needs of veterans. The needs of catastrophically injured veterans are too complex for a standard checklist. Simple yes-or-no questionnaires cannot capture all the nuances of a veteran's life and condition.

A calculator alone should not decide their fate.

VA must enable its people to be... people. VA rating specialists who determine, or rate, a veteran's level of disability and needs must be empowered to go beyond the rules-based algorithms when necessary and use common sense to make sure that America's veterans get what they were promised and have earned.

VA staff should not be required to always insist that severely or terminally ill or wounded veterans submit to additional "C&P" (Compensation and Pensions) exams when the medical record more than adequately supports the claim. For some of our most disabled and ailing veterans, waiting sometimes months to be scheduled for "just one more" test or filling out yet one more lengthy form can put unnecessary delays between them and the benefits they've earned.

For veterans with ALS (Lou Gehrig's disease), a painful, aggressive and debilitating neurological disease that is almost always fatal, delay of benefits can be equal to denial of benefits. When VA rules-based processes can require these veterans to complete yet another questionnaire despite strong clinical evidence -- such as being in hospice care -- when there is no time and no need to wait for a rating decision. These veterans may die before receiving any benefits -- benefits that could make their final days a bit more comfortable.

When Paralyzed Veterans' leaders recently testified on Capitol Hill, we asked VA to:

• Assign cases involving complex, severe conditions only to the most experienced raters, and empower them to make judgments and recommendations not based exclusively on rules-based calculator results

• Ensure that new raters are properly trained in the handling of severe disability claims, to increase the number of talented VA professionals who can properly handle complex cases

• Empower rating specialists to make common sense overrides, and fully implement and train them about the reasonable doubt doctrine, which requires that when the evidence for and against the claim are equally compelling, VA must resolve doubt in favor of the claimant

• Expand the "acceptable clinical evidence" option to allow VA rating specialists to gather medical information by phone instead of having veterans with severe disabilities forced to report in person for examinations.

In essence, we asked that VA staff be empowered to balance the push for more timeliness in the adjudication of claims with common sense reasoning to ensure complete accuracy, especially in the most severe and complex cases.

We are heartened to learn that some VA regional offices took note, such as in Nashville, where immediately following Paralyzed Veterans' testimony, the regional office announced that it will be implementing several important changes in the way in which it handles ALS cases:

1. Paperwork will no longer be sent offsite for scanning to process the claim (adding unnecessary time to the process).

2. VA staff will undergo intense training regarding ALS cases so they better understand the medical dynamics inherent in an ALS diagnosis.

3. VA will make a decision about the claim within three days of submission.

We applaud the initiative of the regional office in Tennessee in adopting a common sense approach to handling ALS cases and hope that all VA regional offices follow with similar policies. Let's not lose sight of those who need VA help the most. We urge VA leaders to exercise their power to make sure veterans get what they need and what they have earned.