Have you witnessed VA Disability fraud?

2014-11-22T20:52:59-05:00

This article from last month talks about the increase in VA disability claims and the potential for increased fraud:

http://online.wsj.com/articles/va-disability-claims-soar [login to see]

This isn't necessarily new, but lingering problems from deployments, current operations, and the increase in veterans leaving the service certainly makes the volume of claims higher and fraud along with it. Particularly troubling is the VA's effort to process veterans as soon as possible and how that can lead to marginal and fraudulent cases being awarded disability.

During my senior year of college, I experienced regular back pain after an extended period of relatively strenuous ROTC training the previous year. I eventually brought it up to one of my instructors and I'll never forget the exchange that followed:

Me: Are injuries that we sustain during ROTC covered by the Army or anything?

Instructor: No, not until you commission. Why, what's up?

Me: My back has been killing me since [whenever]. It started after [that painful training thing we did], sucked all throughout LDAC, and hasn't stopped in the few months since I got back.

Instructor: Hmmm...are you sure you didn't hurt your back during your next deployment?

What do you think? Have you had any experiences like this, or known someone who has made a false claim to get disability payments?

VA Disability Claims Soar

Requests for disability pay by veterans have ballooned during the past five years, overloading many doctors who evaluate the claims and increasing the possibility of fraud, according to current and former VA staff and government watchdogs.

Response by MAJ Private RallyPoint Member made Dec 1 at 2014 9:02 PM

2014-12-01T21:02:18-05:00

1LT(P) Private RallyPoint Member I've seen a similar instance where a guy got banged up in ROTC. He ended up making it to BOLC before it became too much. Had he not made it to commission he would have had a bad back and nothing to show for it.

Response by CW5 Private RallyPoint Member made Dec 1 at 2014 9:59 PM

2014-12-01T21:59:26-05:00

That's an excellent question, 1LT(P) Private RallyPoint Member. I don't know of such cases for sure, but I suspect that some people are milking the system for all they can get. And that's a problem for the rest of the deserving veterans who should get disability for honest-to-goodness problems they have from time on active duty / deployment. I believe that's part of the reason why the VA disability physical process can be such a challenge.

Response by SFC Matthew Parker made Dec 2 at 2014 11:55 AM

2014-12-02T11:55:02-05:00

1LT (P),
I have seen it first hand from inside the VA. During my retirement physical I was told to file VA claims and wasn't to thrilled at asking for compensation for injuries after doing my job. But the doc and admin folks insisted and I filled out the paper and sent it in.
I had a physical in DC at the VA hospital and it was a absolute joke. 30 minutes to look at multiple injuries and to fill out a questionnaire on when and how I was injured.
A year later I get a letter with 12 injuries listed and a percentage for each, 10% for leg 10% for arm etc. The letter listed things I didn't have and denied % for a gunshot wound. I was found not service connected for getting shot in Iraq.

Went back for follow up last year and got another letter, all of a sudden I was fine, arm, leg all better. Funny the doc never looked at the arm or leg but I was all better. Can you say cut and paste. They pasted my name on another report and just sent it up.

Last week I was seen again by the VA and the leg and arm are not better, weird how things just go bad after a miracle healing. I told the VA about the report being wrong, they refused to correct it, I filed a VA IG complaint with no response, I went to see the VA Hospital chief, couldn't get in to see him and finally called my congressmen.

I know there are those who complain about a minor injury and get what they can, there are books on how to answer the doctors questions at the exam. How to present your injury the best way to get paid. But there are also those really hurt that are not getting what they earned because the system is so poorly managed.

We have more vets with more lasting injuries thanks to Iraq and Afghanistan, we need a better system to take care of them.

Response by LCpl Private RallyPoint Member made Dec 2 at 2014 12:33 PM

2014-12-02T12:33:17-05:00

Its not easy to receive approval from VBA for a original disability claim, in fact more than half are disapproved due to lack of strong evidence. I agree veterans leaving the service certainly makes volume of claims higher, but no worries VBA hires new employees each year to compensate.

I am aware number of fraudulent cases from OIG of veterans whom submitted false documents. Those individuals have been fined and or servicing jail time. VA is required to randomly monitor and review C/P veterans every year.

Response by 1LT Nick Kidwell made Dec 3 at 2014 1:36 PM

2014-12-03T13:36:53-05:00

Yeah, upon de-mob, we were advised to file a disability claim right away as we likely all had tinnitus. Wink-wink, nudge-nudge.

Turns out I do have tinnitus, plus hearing loss, plus back issues, plus GERD, plus an inner ear issue that is likely related to service-connected auditory trauma...but I digress.

Yeah, I have witnessed it. Really, it comes down to personal integrity.

Response by PO1 Private RallyPoint Member made Dec 3 at 2014 9:19 PM

2014-12-03T21:19:14-05:00

First of all - there's fraud. Period. It exists.

With that said - let's clear the air about some misconceptions. The VA benefits sections, the one that deals with VA benefit claims is not the same as the military's MEB system. The methodology is different and the metrics are different. The military's MEB system is used to determine if you can continue to be a fully functional and productive member of the military. This is how SM's get a zero percent rating from the MEB and discharged. I hear it constantly - people tell me they can't apply to the VA because the already have a zero percent disability from the Army/Navy/Marines/Air Force. When I am finally able to talk them into going through the process with the VA claim - well, lo and behold, they have a 10% or a 40% or a 50% disability rating from just what their military records say at first glance. HOLY Mackerel Batshite!

VA's disability rating is not the same as Social Security or the military's MEB - don't make the mistake of thinking that someone on 20% VA disability is shamming. The VA's rating only means that the evidence provided and confirmed by the Compensation and Pension exams says there are at least one and possibly two injuries that occured in the military and are still having a negative effect on the claimant at the time of the rating award. That could be as simple as a hand injury while on AD or training that was seen by the unit medic, treated and the SM was returned to duty with appropriate annotations on the SM's medical file - but now, 5 years, 10 years or 20 years later, after the SM is out of the service and there are lingering issues on that hand today. Maybe the unit medic sent you to get an x-ray and the x-ray tech forwarded the x-rays for evaluation BUT the evaluation by the expert didn't get back to the unit medic until months or years later. Turns out, the SM suffered a series of broken bones - albeit small "green-tree" fractures and though the SM kept coming back to the medic for pain (and the SM earned the title of "sick-bay commando" in the process) for which the medic issued what? oh yeah....MOTRIN and told the SM to get back in the field. Trust me, it happens all the time. By the time the evalutation is forwarded back to the unit, the breaks have fully healed - and no further action is needed. But 20 years later, the bones are again causing pain - evaluation and x-rays reveal issues that might range from total inability to use the hand to mild arthritis. VA evaluations sez: there was an injury in the military and now there are continuing issues - the issue is attachable to military service as the probably original cause, ergo the claimant can be issued a 10% disability rating (*****warning! There way too many possibilities to take into account - this is only a possible example *****). Sure the money isn't a lot, but any care on that hand for anything related to the broken bones, etc is now the full responsibility of the VA healthcare system - and it's all at the expense of the VA.

So, now a friend of the claimant, who served with them - but only knows the part where the claimant was called the "sickbay commando" for his hand pain - but NOW sees and hears the claimant saying they got a disability from the VA for their hand and who is proud as a rooster for actually getting anything from the VA. So now the friend is thinking FRAUD!

Is every situation like this? - nah. But there are enough situations similar to this to suggest a caution - yes there may be fraud involved. A disability rating by the VA does NOT automatically mean someone cannot have a full time job and work hard.

Response by SSG William Patton made Dec 4 at 2014 11:37 AM

2014-12-04T11:37:17-05:00

I know fraud exists in the VA system, as it does in any system where people can receive money for not working. However, having gone through this system and having to appeal the decisions on multiple occassions, I find it difficult to see how fraud can be rampant or even at a level where it is problematic. Besides myself, I know of several people with serious, service connected disabilities, having a very difficult time getting the compensation they deserve. My issies stem from injuries and wounds sustained that were not documented due to the fact my medical records were not available in the field hospital I was treated at, and the medic did not forward paperwork to the company clerk to be entered in my personnel file. This was not known until I filed my claim 7 years ago, and as a result, I am having the fight of my life to get the claim approved for my back injuries sustained while humping 175 mm projectiles, malaria, and a shrapnel wound I received. Without supporting evidence, the VA will not approve the claim.

Response by PO2 Corey Ferretti made Dec 5 at 2014 1:49 PM

2014-12-05T13:49:36-05:00

I have not seen fraud that i know of; but have seen people who milk the system for every penny and benefit they can get from it. It pisses me off but there is no rules that say you cant milk the system for what it is worth. I meet a person who is working towards 100% working rating. He is not lying to them about what is wrong he is just finding ways to get to what he wants.

Response by SSG Dwight Amey MSA, MSL, BS, AS made Jan 4 at 2015 8:59 PM

2015-01-04T20:59:23-05:00

Talking with veterans every day at the VA (MyHealtheVet & Ebenefits Tech Support) I have talked with many that have had their payments stopped for missing annual appointments, not following treatments. On one conversation a WWII vet with COPD was down graded when the VA decided he was no longer prohibited by COPD and reduced his claim. In your case I would get an MRI if authorized. I got back pain and after 22 years of active duty and having three x-rays and diagnosed with a lower back strain. During my C&P Exam those same x-rays were used to award me 10%. Once I got with my primary care doctor (ex-special forces soldiers nco and officer) explained my back pain after running or sleeping. He looked my x-rays and decided to order an MRI. He found that my spine is degenerating authritus. He says that my back injuries is exactly what he sees with many veterans who did much rucking, lifting, and ridding in vehicles being bounced around with heavy body armor. If your body hurts get medical proof. X-rays don't lie and MRI's either. Take Care.

Response by MSgt Mike Brown; MBTI-CP; MA, Ph.D. made Jun 12 at 2015 8:17 PM

2015-06-12T20:17:22-04:00

The shame of this, is it takes away valuable resources for those of us who depend on something seemingly as mundane as eyeware... My care at the Oceanside VA optometry clinic has been superlative, and many hour are spent "chasing a moving target with my vision, just to try to get something reasonably in the ball park."
Further -- for what? To earn a few dollars more a month? You cannot buy your health, and for the last time I will state, I would give every penny back not to have 14-pair of eyewear over the last 8-10 years...There is no honor in feigning an illness, or some crazy symptom to receive ill gotten gains - at the cost of our nation.

Response by MAJ Ken Landgren made Jun 12 at 2015 8:42 PM

2015-06-12T20:42:35-04:00

What a divergent world as some of us try to act normal and others pretend to be crazy. Good topic!

Response by CPL Eric Allen made Jun 12 at 2015 11:10 PM

2015-06-12T23:10:58-04:00

I once saw this guy who was suppose to be in a wheel chair he had all he placards for being in a wheel chair and i could tell he didn't need to be in a wheelchair jumping all around his ford F350.....

Response by SPC David Hannaman made Sep 21 at 2015 1:48 PM

2015-09-21T13:48:04-04:00

This one tears at my heart more than a little. It seems that "disability" has become the new "welfare".

I personally know several people who are able to work but don't because they're "disabled". I can also think of several examples of people who I would have no trouble whatsoever if they went on disability for the rest of their lives and I supported them with my tax dollars, but choose instead to contribute to society.

So what is the answer? I can't come up with one.

If someone looses their hearing in training are they disabled? Probably. Is there a way they can still contribute to society? Yes.

This isn't a military only phenomenon either, I've seen it happen in people that get a federal disability check, but yet manage to visit "Disney Europe" and spend the weekend in a "mini-vacation" (nice hotel room, Eagles concert).

If someone is HIV positive, but it's in remission to the point where they're comfortable having children naturally with a non HIV positive spouse (without fearing that they would give them HIV) should they still be getting disability?

It's easy to say "not my circus not my monkeys" on this one, but "social programs" are a large slice of the federal budget pie so it IS our circus.

Response by CPO Kenneth Wilkinson made Oct 25 at 2015 2:25 AM

2015-10-25T02:25:55-04:00

I have seen Vets fake mental illness more than once. They even brag about getting over on the VA.

Response by 1stSgt Sortssux . made Nov 6 at 2018 12:33 AM

2018-11-06T00:33:14-05:00

I have seen a guy working in our shop doing heavy physical work, climbing up and down from equipment and lifting heavy objects. He is retired from the US Navy and he says he has 100 percent from the VA from which he gets a monthly check along with his pension. I am confused how can a man get a 100 percent disability fro the VA yet still be able to work in a labor intensive job? It seems to me that this is some sort of fraud.