VA Admits it Can't get Back Pain Claims Right | South Portland, ME

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VA Admits it Can’t get Back Pain Claims Right

Published on March 6th, 2020

A new report from the VA’s Office of the Inspector General called into question the administration’s ability to accurately process claims involving back pain and other conditions of the spine. The report, entitled “Accuracy of Claims Decisions Involving Conditions of the Spine,” concluded that the VA incorrectly processed over 60,000 claims for spine conditions over a six month period. This is a huge issue, given that over 1.5 million veterans are now receiving compensation for their back pain, which is in the top 10 of the most common service connected disabilities.

The report concluded that these inaccuracies are the result of improper procedures, where medical examiners and ratings representatives are called to approximate objective medical symptoms. The VA ratings guideline for spinal conditions uses many non-medical terms that do not line up with actual medical concepts or observations. This issue illustrates the importance of having a skilled advocate to assist you if your claim has been denied. If you want a second chance at getting your veterans compensation, call Jackson & MacNichol today at 1(888) 492-2941 for a free consultation.

VA Report Describes Systematic Failures to Fairly Evaluate Spinal Conditions

The goal of the VA study was to determine if VA staff are accurately processing veterans’ primary and secondary claims for conditions of the spine. A secondary condition is one that is caused by your primary condition. For example, your primary spine condition can cause nerve complications including pain, numbness, and tingling. These symptoms would be considered a secondary condition. Under the Code of Federal Regulations (C.F.R.) you are entitled to compensation for both your primary and secondary service-related conditions.

The Inspector General looked at a statically representative sample of claims involving back pain, which allowed it to determine that approximately 62,500 claims were improperly decided between January and June, 2018. The root causes of the improper review claims included:

  • Processing errors–The study found that around 34,700 claims were processed incorrectly, resulting in inaccurate payments to 29,800 veterans totaling almost $6 million. The processing errors in many cases were the result of clerical mistakes from under trained or overworked staff.
  • Improper medical evaluations–Medical examiners are instructed to provide their opinion of whether your range of motion is limited during flare-ups or repetitive tasks. If the examiner declines to give an opinion, they must explain why. Adequate explanations include a general lack of knowledge or a preference to not issue an opinion on non-observed symptoms. However, most of the claims did not include a statement as to why the examiner did not provide an opinion on range of motion.
  • Missed secondary conditions–The medical examination form asks the examiner to categorize secondary neurological complications as mild, moderate, or severe. But their choice was not always consistent with other symptoms that they documented. Some examiners  complained that they did get enough guidance on these disability levels, which are based on VA’s own terms rather than accepted medical terminology.
  • Inadequate rating guides–Once the medical exam is complete, a rating veterans service representative (RVSR) reviews the exam report and determines your rating. But the disability rating schedule they use does not contain objective criteria for evaluating disability based on neurological issues resulting from a spinal condition. As a result, some ratings failed to take peripheral nerve damage and other neurological complications into account.

When medical examiners and rating presonnel are guessing about how to categorize and rate your spinal condition symptoms, it demonstrates severe shortcomings in the VA’s evaluation process for compensation claims. Fortunately, you can appeal the denial of your claim or an unfairly low disability rating with the help of a veterans benefit lawyer.

Jackson & MacNichol Can Start the Appeals Process Today

Our mission is to ensure that clerical errors, botched examinations, and vague rating decisions won’t keep you from getting the compensation you deserve. When we appeal your claim, we will ensure that the VA gives your case a thorough look and that it makes the proper rating decision. If you have been denied your veterans disability compensation, call us today at 1(888) 492-2941 for your free consultation.

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