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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?
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?
Disability
Benefits
VA Claim
Fraud
Posted 11 y ago
Responses: 14
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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.
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.
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1LT(P) (Join to see)
Thanks for the information, PO1 (Join to see)! And some very good points that also make me wonder - how many service members are eligible for disability but never thought to apply? The total outlays for disability payments may be vastly smaller than it could be if every single eligible person was evaluated and given a rating. However, I'm sure that in this case, the VA would have to change eligibility requirements, if for no other reason than to not bankrupt the Treasury.
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That's an excellent question, 1LT(P) (Join to see). 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.
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MSG (Join to see)
Exactly right. I was distressed when I received a benefits guide from VA that was customized for me--my information--who I needed to contact for this or that for my location--that's a lot of money to produce something like that they they could be spending on other people.
And, yes, should my circumstances change, I can still re-enroll.
And, yes, should my circumstances change, I can still re-enroll.
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SGT Thomas Lucken
I to am like SGT Northacker! I did not use the VA when I got out, felt that issues from the military were minor then. But years later they caught up to the point, I am limited at work I can do!!!! Neuropathy is taking it's toll on my arms and legs!
If detected earlier, would I possible be in better shape? Dioxins is one that seems turn up later in life. Even my own son who has spinal bifida (direct birth defect of Dioxins/Agent Orange), we did not know about his issue till 24 and was the VA the caught it...... I have several Dioxin related diseases that has cropped up on me the last few years, that is taking it's toll now.
My 2nd initial claim has been in for 9 months now, part of it is also my son's claim that is in, who is dealing with PTSD, back, and right knee issues!
If detected earlier, would I possible be in better shape? Dioxins is one that seems turn up later in life. Even my own son who has spinal bifida (direct birth defect of Dioxins/Agent Orange), we did not know about his issue till 24 and was the VA the caught it...... I have several Dioxin related diseases that has cropped up on me the last few years, that is taking it's toll now.
My 2nd initial claim has been in for 9 months now, part of it is also my son's claim that is in, who is dealing with PTSD, back, and right knee issues!
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SGT Craig Northacker
The sad part is that it is so unnecessary for all of us. All we want is to do the right thing, and when that does not happen we revert to our PTSD, and now the VA becomes our foe. I have related that to top brass at the VA, land their are great people there, but the inbred policies are horrendous.
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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.....
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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.
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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.
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.
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1LT(P) (Join to see)
I agree...taking from the government is one thing, but it's disgraceful when it hurts other deserving vets. Which makes me wonder how many people commit fraud thinking that they're just taking a bigger scoop out of an endless honey pot, and how many do so fully knowing that it will make it harder for others?
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MSgt Mike Brown; MBTI-CP; MA, Ph.D.
I would say there is a sub-culture of those seeking a higher rating than they initially received -- making an injury seemingly worse than it is... They witness, and here about the "thousands of dollars" receieved for being rated at 100% -- BUT does anyone really desire a life of: becoming severely ill, a myriad of health problems -- ALS, Parkinson's, MS, fibromyalgia -- some were diagnosed while in service -- for others, it does seem to take time for the poisons, toxins, exposures to effect your well-being and health. My lenses cost greater than $1,500.00 per pair, and if it were not for the fantastic eye care, I wouldn't be typing this --- what I d not understand, is that while the health care I excellent (at least my experience), the voc rehab is horrendous. There's nothing worse than wanting to again enter the work force, and not even getting to sit down at the "counselor's" office.
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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.
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.
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1LT(P) (Join to see)
1LT Nick Kidwell were there any vocal objections in your unit? Or was it so hush-hush that people either silently did or did not file a claim?
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1LT Nick Kidwell
If they were vocal, I didn't hear them. I left the military shortly thereafter, so I did not formally follow through.
However like my case, those with whom I did have contact with afterwards did indeed have legitimate claims for various issues.
However like my case, those with whom I did have contact with afterwards did indeed have legitimate claims for various issues.
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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.
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.
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1LT(P) (Join to see)
LCpl (Join to see) I'm not sure I agree. There are a bunch of stories floating around about how the VA claim process can completely break down, including SFC Matthew Parker's story above. It isn't a problem that can be solved by just "hiring new employees"; the decisions are made by individual medical providers, which are in short supply these days. The fact is that the VA has openly demonstrated an intent to process veterans as quickly as possible, putting the integrity of the process at great risk. It is a virtual certainty that not all fraud cases are discovered and prosecuted.
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LCpl (Join to see)
Every state in our great country has an VA RO that independently accepts, evaluates and rates each and every claim. I have heard a number of stories and majority of them are not true. Unfortunately some are. You have high performing VA RO's that do well and veterans are happy and you have some RO's that do not and veterans are unhappy. Every VA RO is given adequate resources, to include staffing to handle their individual workload timely. The blame should be focus on management, not holding VA employees accountable for poor performance. I was once a mid manager with VA and did hold every employee under my authority accountable for the actions/work. My division one of the best when I departed.
I personally believe every veteran with strong documented service connected disability should be timely entitle to VA benefits/services. Unfortunately, I am not the Secretary of Veteran Affairs only he and Congress can make changes that will positively improve VA services.
I personally believe every veteran with strong documented service connected disability should be timely entitle to VA benefits/services. Unfortunately, I am not the Secretary of Veteran Affairs only he and Congress can make changes that will positively improve VA services.
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SFC Matthew Parker
LCpl Lewis,
I had my review last June and my C&P doc filed a false report he cut and pasted my name on. he reported no scars, and after 13 surgeries I think I have more than one. He reported vast improvements in my knee my surgeon found hilarious as he issued me a new $900 dollar knee support and a $20 dollar cane.
Thanks to his report they wanted to reduce my compensation, I had the appeal physical last week and the doc says I need a new knee in the near future.
The C&P exam process and the review process is broken and when I brought the medical records to the clinic chief to prove the report was wrong he refused to recall the report. He didn't want to "admit" to a mistake. Now that firing VA staff is easier I hope they replace these people with veterans and medical cadre that care enough to not cut and paste a report.
I had my review last June and my C&P doc filed a false report he cut and pasted my name on. he reported no scars, and after 13 surgeries I think I have more than one. He reported vast improvements in my knee my surgeon found hilarious as he issued me a new $900 dollar knee support and a $20 dollar cane.
Thanks to his report they wanted to reduce my compensation, I had the appeal physical last week and the doc says I need a new knee in the near future.
The C&P exam process and the review process is broken and when I brought the medical records to the clinic chief to prove the report was wrong he refused to recall the report. He didn't want to "admit" to a mistake. Now that firing VA staff is easier I hope they replace these people with veterans and medical cadre that care enough to not cut and paste a report.
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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.
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.
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1LT(P) (Join to see)
SFC Matthew Parker I agree wholeheartedly, and I hope you get the resolution you deserve. It is the fraud and abuse of the system that makes it so hard for veterans with long-term injuries to get proper evaluation and benefits. The worst part is that many veteran perpetrators will vehemently criticize those who cheat the welfare system, but then turn around and cheat a similar program that they are not entitled to.
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1LT(P) (Join to see) 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.
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1LT(P) (Join to see)
MAJ (Join to see) I actually just found this form, which unless it was superseded, would seem to indicate we were eligible to at least seek treatment from military facilities...
http://www.rotc.pitt.edu/forms/cc-136-r.doc
http://www.rotc.pitt.edu/forms/cc-136-r.doc
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MAJ (Join to see)
1LT(P) (Join to see) That's a new one for me, but glad they have it. I used the University clinic when I had some achilles problems.
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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.
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