By Thomas D. Begley, Jr., CELA

This is the second in a series of articles dealing with lien resolution in personal injury cases.

Medicare Advantage and Prescription Drug Plans

Medicare Part C. commonly known as Medicare Advantage, is a Medicare substitute program operated by private health insurance companies as a managed care plan. Medicare Part D similarly provides prescription coverage to eligible beneficiaries through private insurance plans. To the extent a reimbursement right may be created under a specific MAO plan, the Part C statute itself limits any recovery from a beneficiary to the amount actually received from a third party as payment for plan-covered expenses.1

ERISA Plans

Generally, employer-sponsored benefits plans are governed by the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA.2 However, certain employers and their benefits plans are not subject to ERISA. These include governmental plans;’ church plans:’ plans maintained solely for the purpose of complying with applicable Workmen’s Compensation, unemployment compensation, or disability insurance laws;5 a plan maintained outside of the UnitedStates primarily for the benefit of persons who are virtually all non-resident aliens;6 or an excess benefit plan.” ERISA preempts state law that “relates to” an ERISA governed plan;8 however, ERISA does not exempt or relieve any person from complying with any law of any state that regulates insurance, banking, or securities.9 Neither an employee benefit plan nor any trust established under such a plan shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company.10 As a result of this statutory framework, any self-insured employee benefit plan regulated under ERISA enjoys federal preemption of state law, but an insurance company insuring such a plan does not. Such insurance companies are regulated by state law, including laws concerning subrogation and reimbursement.11 If an ERISA plan is insured, the insurance company is subject to state law and the plan is bound by state insurance regulations insofar as they apply to the plan’s insurer. ERISA itself is silent with respect to subrogation and reimbursement, neither requiring a welfare plan to contain a subrogation clause nor barring such a clause or otherwise regulating its content12

Federal Employee Health Benefit Act

The Federal Employee Health Benefit Act (FEHBA) provides group health insurance for federal employees.13 Although there is no statutory right of subrogation or reimbursement. FEHBA contains a preemption provision under which the terms of insurance contracts issued by its private carriers purportedly preempts state and local law.1″1 However, the Supreme Court has held that FEHBA does not provide contract insurers with a federal cause of action or federal jurisdiction in a subrogation/reimbursement claim, leaving the matter to the state courts, and it further called into question whether a FEHB plan may assert any contractual recovery right at all against a beneficiary where such claims are prohibited by state law; the Court was “not prepared to say” that a carrier’s contract with the government “would displace every condition state law places on that recovery.”15

Federal Medical Care Recovery Act

The federal statutory scheme provides several independent bases for recovery of medical costs expended on behalf of government personnel and their dependents for injury or disease not connected to their military or other government service, but the Federal Medical Care Recovery Act (FMCRA)16 establishes standards generally applicable to claims of all federal departments and agencies. Significantly, while the government may exercise its recovery rights under the statute by making claims directly against third-party tortfeasors, the statute authorizes no such claims against a beneficiary. The statute provides, inter alia, that in any case in which the United States furnishes or pays for medical or dental care and treatment under circumstances creating third-party tort liability for such expenses, the United States shall have a right to recover from the third party the reasonable value of such care and treatment.17 The United States also has an independent right to recover from the third party the total amount of pay fora member of the Uniformed Services for any period in which the member is unable to perform his or her duties as a result of the injury or disease and is not assigned to perform other military duties.18

Veterans Administration and TRICARE Claims

The Veterans’ Benefits Act19 and the Armed Forces Act20 establish the Veterans Administration and TRICARE/CHAMPUS healthcare programs, respectively. Neither the VA nor TRICARE/CHAMPUS statutes allow for a lien or reimbursement claim against a beneficiary’s personal injury recovery. The government does have a subrogation right if it chooses to pursue its own claim against a third party: however, the statutes specifically governing the programs have a very narrow definition of “third party” that does not include a tortfeasor, but is specifically limited to public and private healthcare payors.21 Moreover, applicable regulations spell out that a beneficiary only has a duty to cooperate with the government’s third-party claim, and the extent of that cooperation itself is rather limited, merely obliging a beneficiary to provide necessary information for the government’s third-party claim.22  Moreover, the government’s claim is expressly limited by both statute and regulation to the extent of liability under state tort law, so federal preemption of state liability rules does not apply.

142 U.S.C. §1395w-22(a).

229 U.S.C. §, 1003.

329 U.S.C. § 1003(b)(1).

429 U.S.C. § 1003(b)(2).

529 U.S.C. § 1003(b)(3).

629 U.S.C. § 1003(b)(4).

729 U.S.C. § 1003(b)(5).

*29 U.S.C. ^ 1144(a).

“29 U.S.C. § 1144(b)(2)(A).

,0 29 U.S.C. § 1144(b)(2)(B).

11 FMCCorp. v.Holhday,498 U.S. 52 (1990).

13 Ryan v. Federal Express Corp.. 78 F.3d 123 (3d Cir. 1996).

13 38 U.S.C.§ 1725(a)(1).

M5 C.F.R. § 890.

15 Empire UealthChoice V. McVeigh.547 U.S. 677 (2006).

16 42 U.S.C. §2651.

1742 U.S.C. §2651 (a).

18 42 U.S.C. § 2651(b).

19 38 U.S.C. § 1729.

20 10 U.S.C. §1095.

21 38 U.S.C. § 1729(i)(3)and 10 U.S.C. § 1095(h)(1).

22 32 CFR §§ 199.12 and 220.9

In 2014, Congress proposed a law that would penalize veterans and surviving spouses of veterans who were looking to apply for the VA Benefit if they transferred assets within the three year period from when they applied for benefits.  If the veteran or surviving spouse did transfer assets, there would be a penalty imposed on the veteran or surviving spouse.

However, that bill failed and never saw the light of day.

VA Benefits Proposed Rule Change in 2015

In early 2015, the VA took another route to get the “3 Year Look-back” rule implemented.  Instead of a change in law through Congress, they looked to change the administrative rules.

With that goal in mind in early 2015 they made a proposed rule change that would implement a 3 year look-back.  There was a comment period that closed March 24th.  There were over 900 people who made comment, including many elder law lawyers.

There were credible rumors in the elder law attorney community that the proposed rule change would go into effect in the spring of 2016.

Another Attempt for Congress to Pass VA Rule Change

The Elder Care Firm’s VA Accredited Attorneys have consistently advocated for veterans, and argued the VA did not have independent authority to make such changes and needed Congressional approval. Apparently the VA agrees, so it secured the support of a few senators to craft a bare-bones House Resolution called the “Veterans Care Financial Protection Act of 2016.” Essentially, this Act would approve any “standards” developed and implemented by the VA “that protect individuals from dishonest, predatory, or otherwise unlawful practices relating to increased pension available … on the basis of need for regular aid and attendance.”

If this Resolution passes, all of the proposed changes to Title 38 of the Code of Federal Register, as drafted by the Veterans Administration, affecting veterans, imposing transfer penalties of up to 10 years, would become law.

However, according to VA law expert Victoria Collier, there is one glaring problem, “neither the bill nor the proposed changes in Title 38 define “dishonest, predatory, or otherwise unlawful practices.””  For example, lawyers who draft estate planning documents, licensed to do so in the state where the client resides, are acting lawfully. Certainly, misrepresentation that a trust or an annuity is required in order to get VA benefits is dishonest.  But making transfers of assets to trusts and the purchase of an annuity itself are not unlawful.  Holding educational seminars is not predatory.

Collier goes on to comment, “This is yet another example of a poorly drafted piece of legislation designed to appeal to the emotions of the ignorant, and it purposely does not adequately explain the consequences for or against the cause.”

Veterans will be harmed by the changes in the laws, not protected. The VA could punish the group of professionals using unethical practices or committing illegal acts.

Let your representatives know the real issues behind the reason for this new resolution. Urge them not to pass this blindly – know what the proposed rules are that affect pension benefits and veterans.

Planning ahead for VA Benefits and Medicaid

The earlier a family starts planning for a Veteran or surviving spouse of a veteran, the more options are on the table as the loved one navigates the long-term care journey.  Often, as VA Accredited Elder Law Attorneys, we utilize special asset protection trusts to help qualify for the VA Benefit or Medicaid.

The post VA Tries Again to Get Rule Changes Approved by Congress appeared first on Michigan Estate Planning.

The Veterans Benefits Administration (VBA) recently began to scan and digitally store the multitude of documents received from veterans during the claims process in order to increase efficiency and reduce paper waste. On its face, this idea of a paperless claims process seems to be one of those rare instances in which the Veterans Administration is acting in the interests of those it is intended to serve. What’s not to love about an environmentally conscious initiative that will grant applicants access to all documents during the claims process via the internet, thereby reducing the claims processing time?

Well, it seems as though this was an empty promise. Per usual, the VA carried out this digital transition consistent with its longstanding tradition of incompetence. At best, VA employees were ill-prepared and overwhelmed by the volume of work that was required to complete this. The more likely story is that the VA sought to push their workload and responsibilities onto a third party, inevitably delaying the claims process.

The idea of an efficient Veterans Administration is a paradox, and this paradox is best displayed in the recent investigative report conducted by the VA Office of Inspector General on the St. Petersburg Regional Office (RO). Initiated after receiving a tip from St. Petersburg RO employees, inspectors looked into the nearly 30-day increase in average wait time for claims processing.

From June 2014 to December 2015, the average wait time at the St. Petersburg RO jumped from 152 days to 179 days. What’s troubling is that VA officials announced an 88% decrease in backlogged claims during the same time period. Additionally, the St. Petersburg RO was well-underway in the digital transition that was supposed to result in a reduction in the claims processing wait time. So what went wrong?

In order to carry out this digital transition, the VA contracted out the scanning process to CACI International. VA employees were to compile the hardcopy documents received from veterans, place the organized file into boxes, and ship them to the CACI scanning center for digital conversion and storage. The program’s reliance on VA employees to effectively carry out this new responsibility seemed problematic from the start, not to mention the unnecessary addition of a third party transaction for the sake of efficiency.

As it turns out, you cannot teach an old dog new tricks. Investigators uncovered a backlog of nearly 1,600 boxes and 42,000 packages sent by mail. Contained within these boxes and packages were individual claims sitting unprocessed at the CACI scanning center. The mountain of unprocessed claims was a result of the St. Petersburg office’s “inefficient preparation and handling of veteran-provided documentation.”

The boxes received by the CACI were filled with loose papers with sensitive information for multiple veterans along with irrelevant documents such as blank pages. The result was a nearly tenfold increase of unprocessed veteran claims materials shipped from St. Petersburg to the CACI center.

Even those documents lucky enough to be processed were taking six times as long as they were supposed to. Far more problematic than the slower processing time was the post-scan storage of this sensitive information. Apparently, CACI thought it would be okay to toss them into the nearest utility closet: “We [VA Office of Inspector General] observed a large amount of hard copy sensitive veteran information haphazardly commingled with contractor company documentation, excess office furniture, and empty computer boxes that appeared to be trash.”

According to investigators, this was not an issue of CACI employment misconduct, but rather inadequate VA oversight. The VA seized the opportunity to lighten the workload and didn’t find it necessary to ensure safe and speedy processing of claims at the scanning center. The report says the unattended claims were “potentially vulnerable to loss, theft, and misuse to include identity theft or fraud.” Needless to say, many documents that veterans submitted to the VA never got scanned into the system or properly attached to the veteran’s file.

So once again, the VA shows how little value is placed on veterans disability claims. The real losers here are the unidentified number of veterans who suffered a longer claims process time, or worse, the loss of their claim altogether. This report affirms the importance of retaining competent representation when filing or appealing a benefits claim with the VA. Don’t rely on the good faith of the VA employees to carry out your claim.

We have a national practice representing veterans from across the country. This representation occurs at the United States Court of Appeals for Veterans Claims, the Board of Veterans’ Appeals and regional offices. We have helped veterans collect over $10,000,000 in retro and future benefits. Over the years, Legal Help for Veterans has become a trusted name in the legal community for providing legal services to veterans.

by Thomas D. Begley, Jr., CELA

Medicare Advantage and Prescription Drug Plans

Medicare Part C, commonly known as Medicare Advantage, is a Medicare substitute program operated by private health insurance companies as a managed care plan. Medicare Part D similarly provides prescription coverage to eligible beneficiaries through private insurance plans. To the extent a reimbursement right may be created under a specific MAO plan, the Part C statute itself limits any recovery from a beneficiary to the amount actually received from a third party as payment for plan-covered expenses.[1]

Veterans Administration and TRICARE Claims

The Veterans’ Benefits Act[2] and the Armed Forces Act[3] establish the Veterans Administration and TRICARE/CHAMPUS healthcare programs, respectively. Neither the VA nor TRICARE/CHAMPUS statutes allow for a lien or reimbursement claim against a beneficiary’s personal injury recovery. The government does have a subrogation right if it chooses to pursue its own claim against a third party; however, the statutes specifically governing the programs have a very narrow definition of “third party” that does not include a tortfeasor, but is specifically limited to public and private healthcare payors.[4] Moreover, applicable regulations spell out that a beneficiary only has a duty to cooperate with the government’s third-party claim, and the extent of that cooperation itself is rather limited, merely obliging a beneficiary to provide necessary information for the government’s third-party claim.[5] Moreover, the government’s claim is expressly limited by both statute and regulation to the extent of liability under state tort law, so federal preemption of state liability rules does not apply.

Welfare Liens

In New Jersey, there is a lien against real and personal property of a person who has been assisted by or received support from any municipality or county. This is true whether a person has been in a county facility or at home.[6]

[1] 42 U.S.C. § 1395w-22(a).

[2] 38 U.S.C. § 1729.

[3] 10 U.S.C. § 1095.

[4] 38 U.S.C. § 1729(i)(3) and 10 U.S.C. § 1095(h)(1).

[5] 32 CFR §§ 199.12 and 220.9.

[6] N.J.S.A. 4:4-91.

A life insurance conversion allows policy holders to use their life insurance as income to pay for assisted living. This process can be complex, and is not available with every policy; however, for many life insurance purchases, it can serve as a tax-free loan.

People who own life insurance policies also have the option of selling their policy with a life settlement or a viatical settlement. Both types of settlements allow the policy holder to sell the policy for more than its surrender value, but less than the death benefit.

Reverse mortgages allow homeowners to use the equity on their home to receive cash, allowing seniors to receive money to pay for assisted living expenses and other expenses they may not be able to cover otherwise. With a reverse mortgage, the lender actually makes payments to the borrower, rather than the other way around.

Long-term care insurance is available, but can be expensive for older adults, with potentially limited benefits. Older adults who already require assisted living are unlikely to qualify for long-term care insurance. Because of the high cost and potential limitations, long-term care insurance is not right for everyone.

Government benefits are also available to older adults who cannot afford assisted living on their own. Veterans may qualify for the Aid and Attendance Benefit through the Veterans Administration. Thanks to Medicaid expansion, more older adults than ever also qualify for Medicaid, which can help pay for assisted living in some cases.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

by Thomas D. Begley, Jr., CELA

This article continues the discussion of special problems for the elderly.  (Here is a link to Part 1.)

• Long-Term Care. About 70% of Americans will require some form of long-term care be it home care at $22 to $25 per hour, assisted living at $4,500 to $8,500 per month, or nursing homes at $10,000 to $12,000 per month. Only about 6% to 8% of Americans have long-term care insurance. Expenses of long-term care will wipe out most families very quickly. The Affordable Care Act has already covered between 10 and 13 million additional individuals. That number would be much larger except that 22 states refuse to expand Medicaid eligibility to their states. The Affordable Care Act, or Obamacare, was merely not health reform, it was insurance reform. Much of the legislation was designed to protect insurance companies. A better solution would have been a single payer health care system. This would have been much more efficient for doctors, hospitals, and other health care providers. Essentially, it would be Medicare for everybody. Individuals would still have the right to choose their own health care providers, but all bills would be paid by an agency of the federal government. The federal government would not control the care, simply the payment. Another factor contributing to rising health costs is that the federal government is not allowed to negotiate prices with pharmaceutical companies under Medicare Part D. Other agencies of the federal government, such as the Veterans Administration, are able to negotiate prices and receive significant discounts.

• Transportation poses special problems for senior citizens living in the suburbs. The suburban lifestyle is based on the automobile, and once the elderly can no longer drive, their ability to live independently is curtailed by a lack of public transportation in suburban and rural areas. Public policy should favor the development of multi-modal transportation systems that are highly inter-connected.

• Housing is the largest category of consumer expenditures for households age 65 and older. Expenditures for age 65 years and older break down as follows:[1]

Housing                                          36.7%

Transportation                             13.34%

Food                                             12.44%

Health Care                                   14.74%

Cash Contributions                          7.9%

Entertainment                               18.84%

[1] The Bureau of Labor Statistics Consumer Expenditures in 2012, www.bls.gov.

Unfortunately, I might have had my hopes too high.  Over the weekend, the Austin American Statesman ran a wonderful project by Jeremy Schwartz that outlined many of the problems facing researchers who tried to launch an expensive brain injury research program in Waco.

If you’re interested at all in brain injuries and brain injury research, I urge you to spend some time with the resources at the project.

Even if you’re not particularly interested in brain injuries, I think the project is still a good example of what journalism could be.  In addition to his written articles, which also appeared in the paper, the project includes video stories and links to the actual documents used to substantiate the article.  It is extremely well done.

Unfortunately, homelessness among former members of the armed services is not all that uncommon. The Department of Housing and Urban Development estimates that, on any given night, there are 57,849 homeless veterans. During the course of a year, about twice as many veterans endure homelessness at least once.

The vast majority of homeless veterans are male (about 92 percent), and a majority are single, urban dwellers suffering from alcohol abuse, substance abuse and/or other disorders. Veterans account for approximately 13 percent of the homeless population in the United States.

The causes of homelessness among veterans are many: a lack of affordable housing, insufficient income, difficulties in transferring military skills into a post-military professional environment and an absence or shortage of a supportive network of family and friends.

Among all possible causes, two of the most telling are inadequate access to health care and the effects of post-traumatic stress disorder (PTSD). These causes suggest that many of the delays in diagnosis and treatment at Veterans Administration health care facilities — as well as restricted eligibility requirements and less-than-prompt care for veterans with PTSD — are taking a greater toll on veterans than one might imagine.

In Michigan, the Detroit-based Michigan Veterans Foundation assists homeless veterans to stabilize their lives and regain their self-sufficiency by offering temporary housing. But a more comprehensive, national effort is needed to help veterans find housing, to provide them with nutritious meals, to get them the health care and counseling they need, and to offer them more options for job counseling, training and placement.

Only then will this nation begin offer a better chance and a more hospitable welcome for our military heroes.

Legal Help for Veterans, PLLC fights for veterans rights. We fight to make sure you get the benefits you deserve from the Department of Veterans Affairs. To learn more or contact a veterans lawyer, visit http://www.legalhelpforveterans.com/ or call 800.693.4800

Hard upon the heels of the ides of November, a report surfaced that technology has made it possible to scan any Veterans Administration identification card issued since 2004 with a smartphone equipped with a bar code app to obtain the cardholder’s Social Security number. Once the veteran’s SSN appears on the screen of a smartphone belonging to a person with a penchant for rapaciousness, he or she possesses one of the more valuable assets an identity thief can pilfer.

And while the foregoing news is deplorable enough — and clearly constitutes an illegal act — another form of exploitation, albeit a legal one, has also turned up in the news in the week before Thanksgiving. In spite of the fact that Congress passed the Military Lending Act in 2006, which was crafted to protect members of the U.S. armed services from predation by payday lenders, the law is not all-encompassing.

The loopholes in the Military Lending Act are proving to be as wide as a jet parked at the Kellogg Air National Guard Base. Some short-term loans are exempt from its 36 percent interest rate ceiling, including those for more than $2,000, loans with terms of longer than 91 days and auto-title loans with 181-day-plus durations.

Many veterans have gone deeper into debt and, in some cases, lost their homes to foreclosure after taking out loans with exorbitant interest rates. These run as high as 40 percent. Such pressures should not fall on the shoulders of our veterans, and they could not have been what the sponsors of the Military Lending Act had in mind.

Legal Help for Veterans, PLLC fights for veterans rights. We fight to make sure you get the benefits you deserve from the Department of Veterans Affairs. To learn more or contact a veterans lawyer, visit http://www.legalhelpforveterans.com/ or call 800.693.4800

The “8 Keys to Success” includes specific steps for educational communities to adopt in order to support veterans. More than 250 universities and community colleges have adopted the 8 Steps to help vets obtain their higher education degrees and then certificates, licenses and credentials to become highly skilled workforce members.

The Education Department brought together more than 100 specialists from nonprofits, foundations, veterans service organizations and recently returned vets to develop an approach which could be applied to both in-person and online or “distance” learning for vets.

The “8 Keys to Success” incorporates sustained and consistent support from campus heads, a culture of trust across the campus, an early alert system to support vets who may be struggling before they are overwhelmed, a designated space for vets on each campus, outreach with local organizations and communities for services, an overarching demographic collection system to track retention numbers and degrees conferred, an offering of professional development for faculty and staff on vet-focused issues, and a system of practices that works for incoming vets.

President Obama signed an order in 2012 to establish protections for military, vets and families, the Principles of Excellence. As part of the Principles of Excellence, the Veterans Administration is expanding its programs, VetSuccess On Campus (VSOC) and Veterans Integration to Academic Leadership (VITAL) programs, designed to put vets in touch with VA-generated resources. VetSuccess On Campus is currently used in 16 U.S. states, in 32 campus sites, and is expanding this year, with thousands of higher education campuses either developing or further expanding Veterans Success Centers in light of the latest influx of investment from the VA.

More returning service members are attending college on their return to civilian life due to the Post-9/11 GI Bill. The VA has paid out an estimated $30 billion since 2009; more than one million vets, service members, families have obtained an education through the Bill.

Legal Help for Veterans, PLLC fights for veterans rights. We fight to make sure you get the benefits you deserve from the Department of Veterans Affairs. To learn more or contact a veterans lawyer, visit http://www.legalhelpforveterans.com/ or call 800.693.4800

The White House is pushing for postsecondary educational opportunities and better employment opportunities for returning veterans. To that end, the Department of Education and the Department of Veterans Affairs are challenging colleges and universities to adopt pro-veteran, pro-education best practices. The “8 Keys to Success” proposed by the Obama Administration was unveiled during the Disabled American Veterans National Convention earlier this year in Orlando, Fla.

The “8 Keys to Success” include specific steps for educational communities to adopt in order to support veterans. More than 250 universities and community colleges gave adopted the 8 Steps to help vets obtain their higher education degrees and then certificates, licenses and credentials to become highly skilled workforce members.

The Education Department brought together more than 100 specialists from nonprofits, foundations, veterans service organizations and recently returned vets to develop an approach which could be applied to both in-person and online or “distance” learning for vets.

The “8 Keys to Success” incorporate sustained and consistent support from campus heads, a culture of trust across the campus, an early alert system to support vets who may be struggling before they are overwhelmed,  a designated space for vets on each campus, outreach with local organizations and communities for services, an overarching demographic collection system to track retention numbers and degrees conferred, an offering of professional development for faculty and staff on vet-focused issues, and a system of practices that work for incoming vets.

President Obama signed an order in 2012 to establish protections for military, vets and families, the Principles of Excellence. As part of the Principles of Excellence, the Veterans Administration is expanding its programs, VetSuccess on Campus (VSOC) and Veterans Integration to Academic Leadership (VITAL) programs, designed to put vets in touch with VA-generated resources. VetSuccess on Campus is currently used in 16 U.S. states, in 32 campus sites, and is expanding this year, with thousands of higher education campuses either developing or further expanding Veterans Success Centers in light of the latest influx of investment from the VA. VSOC is currently located at 32 campus sites in 16 states and is expanding to additional campuses in 2013.

More returning service members are attending college on their return to civilian life due to the Post-9/11 GI Bill. The VA has paid out an estimated $30 billion since 2009; more than one million vets, service members, families have obtained an education through the Bill.

Sources

http://www.wbez.org/news/valor-games-disabled-veterans-begin-108375

http://www.va.gov/opa/speceven/valor_games/

Legal Help for Veterans, PLLC fights for veterans rights. We fight to make sure you get the benefits you deserve from the Department of Veterans Affairs. To learn more or contact a veterans attorney, visit http://www.legalhelpforveterans.com/ or call 800.693.4800

Principi argued that current eligibility requirements are far more liberal than, as President Lincoln once charged, “To care for him who shall have borne the battle and for his widow and his orphan.” He said that the 50,000 veterans wounded inIraqandAfghanistanwho have filed for disability claims are not the reason the system is clogged, but that the system was already overwhelmed by veterans who were filing claims from long-ago service.

“While every benefits system may face the occasional questionable filing, the focus of the VA disability benefits system needs to support the servicemen and servicewomen who need those benefits to which they are entitled,” commented veterans disability attorneyJames Fausone.

Principi called for the restoration of the “integrity” of the Veterans Administration claims system in a keynote address this June at forum on the VA. The forum, co-hosted by Concerned Veterans for America The Weekly Standard magazine, featured Principi’s keynote, where he stated that Congress, vet service organizations and the VA must address the expansion of disability pay eligibility. Principi has called for a “rebalancing” of priorities or the VA system will be at risk, he said. His remarks were in sharp contrast to other speakers, who urged the VA to work more efficiently and faster on the backlog of disability claims still pending.

More than one million claims are filed each year; an estimated 80 percent of these are filed from veterans who served prior to 2001, Principi said. A vet who served a single day inVietnamcan file for medical conditions typically seen in aging men, Principi said, such as prostate cancer, lung cancer, Parkinson’s disease, and Type II diabetes.

It has been 40 years since the end of the Vietnam War, and 37 percent of VA claims have been filed byVietnamvets, twice as many as those filed by recently discharged vet, according to Principi. And, says Principi, as much as 11 percent of claims, 100,000 or more, have been filed by veterans who never saw conflict. Vietnam-era vet claims increased, posited Principi, due to assumptions that “ailments of aging” such as some heart diseases and Type II diabetes, were added to the list the VA accepted as caused by exposure to Agent Orange.

The VA paid out $26.6 billion in 2005 in disability compensation. By the end of 2013, it will pay out more than $60 billion.

Source

http://www.military.com/benefits/2013/07/03/principi-eligibility-explosion-behind-va-backlog.html?comp=1198882887570&rank=6

Legal Help for Veterans, PLLC fights for veterans rights. We fight to make sure you get the benefits you deserve from the Department of Veterans Affairs. To learn more or contact a veterans lawyer, visit http://www.legalhelpforveterans.com/ or call 800.693.4800

Disabled vets are still waiting too long for medical benefits.

InSeattle,Washington, 25,000 disabled vets are still waiting to receive medical benefits. According to a new report, it could take a year or more for those benefits to be processed.

Claims by disabled vets to the Veterans Administration have at least tripled throughout theU.S. since 2010, and the influx ofIraq andAfghanistan returning home has helped to overburden the already-strained disability benefits system. Adding to the mix is a new, electronic medical and service record system.

“There are at least 2.1 million claims for vets currently pending before the Veterans Benefits Administration,” commented veterans disability attorney James Fausone. “These men and women deserve to better supported be by their government, and not have to wait an egregiously long time for basic benefits to which they are entitled.”

One such vet who is still trying to get his benefits is Seattle-based Aaron Bisol, who says his wait has lasted, at last count, more than 505 days. Bisol completed two tours inAfghanistanas part of the airborne infantry, and sustained a leg injury and damage to his hearing while serving. He filed his medical claims with the Veterans Administration in October 2011, and has yet to begin receiving his benefits. When he calls the VA 1-800 number, he says that he typically waits on hold for two hours before speaking with someone. 

A study recently released by the Center for Investigative Reporting found that the wait nationally for vets is 273 days, on average. The time can vary by state:Seattle vets wait an average of 323 days; andNew York City vets can wait as long as 600 days for their benefits. Even the assistant supervisor of Seattle Disabled American veterans, Greg Kotanchick, had to wait for four years for his claim to go through after hisPersian Gulf service. Kotanchick has stated that he , too, believes the new electronic records system is likely to blame for the long processing time.

The VA has stated that it anticipates the two-year backlog of claims will be cleared within 90 days once the system is fully operational and running at top speed.

 Sources
http://q13fox.com/2013/03/13/huge-va-disability-backlog-frustrates-local-veterans/#ixzz2OmCiV9qN
http://q13fox.com/2013/03/14/disabled-vet-says-hes-been-waiting-more-than-500-days-for-va-benefits/