May 21, 2019

State of Alabama
Press Release: Alabama Department of Veterans Affairs

Claims Analysts Help Veterans Win Appeals

Alabama is home to more than 360,000 veterans of U.S. military service. Some served a few years before moving on to the next chapter in their lives. For others, the military became their career for 20 or more years.

Upon leaving the armed services, veterans become eligible for multiple programs, from health care and special loan programs to educational benefits or financial payments for their spouse or children. But it can be a complicated, confusing process to apply for these benefits.
The VA has a system for rating how disabled each veteran is, based on the evidence in the claim, a medical exam, and other information. If the veteran disagrees with all or part of the VA’s decision on the claim, they have one year to begin the appeal process.

“Most of the time, when they get to us, they have already filed an appeal through the county VSO,” Belinda Pierre, a claims analyst, said. “They are scheduled for a hearing and then we get assigned a hearing.”

The hearing is assigned at random and there is no way to tell if you have a winning case until a claims analyst gets assigned the particular case. “Sometimes we do have good ones that we can see that it initially should have been a grant and it’s been sitting out there for 7-10 years,” she said.

The VA estimates it takes three to seven years on average for veterans to get through the appeals process. After that, the Board of Veterans Appeals has to make a decision which tacks on another one to two years. With a remand, it takes about 10 years. “Claims are remanded to gather more evidence, schedule needed medical exams, request medical opinions, or fix procedural errors created during the adjudication process,” Pierre said.

“The BVA reviews entire file and gives specific orders and directions to the appeals management center or to the regional office of what they are looking for or how the exams should be conducted (if it was done wrong the first time),” Pierre explained. “When the directed actions have been completed the case is returned to the judge at the BVA for a decision.”

Once the claims analyst is assigned a hearing, they review the claim to determine the cause of the denial of benefits and see what the veteran needs to be service connected. The department’s claims analyst digs into the file to identify items that may have been overlooked, misplaced or misfiled years before. The analyst is also reviewing to ensure that the USDVA properly applied all relevant laws and regulations to ensure that the veteran’s right to due process is preserved.

“Sometimes it may be just a diagnosis. The veteran has to have an issue or an illness or injury that happened while they were on active duty,” Frances Kidd, another claims analyst, said. “A lot of the times it’s something that could have been solved earlier. It was something that was overlooked and we point the judge in the right direction.”

Pierre and Kidd recently helped with several appeals that resulted in large retroactive payments for the veterans. One involved a veteran who came in for a video hearing on tinnitus and hearing loss. “The veteran just came in for better hearing aids because the ones the VA provided weren’t very good,” Pierre said. The veteran’s claim was denied because his records were destroyed in the National Archives and Records Administration fire in 1973.

“We made the argument that it was not the veteran’s fault that his records had been destroyed,” she continued. “The veteran was an infantryman who had fought in the Korean War, so the presumption was already there that that he was exposed to noise. The judge agreed and the veteran was granted $10,180.20 in retroactive payments for his tinnitus.”

The hearing loss claim was remanded for an examination. Once the examination came back, the veteran was granted hearing loss at 100 percent rate on March 7, 2019 with an effective date of May 31, 2011 which resulted in a retroactive payment of $269,627.67.

Another case involved a veteran’s spouse who filed an application for dependency and indemnity compensation (DIC). “She was married to the veteran for 23 years and then they divorced. The veteran died about a month after they remarried,” Kidd said.

The VA denied the claim primarily because she was not married to the veteran for at least one year prior to his death. “The VA was supposed to look at the longest period of marriage, which was 23 years,” she said. “It’s a shame that she had to go through a long process of filing a claim, then filing an appeal after being denied, when all the VA had to do is look at the first marriage.” The veteran’s spouse received $107,774.04 and now receives a monthly check for death benefits.

Being a claims analyst is a very rewarding position for both Pierre and Kidd. "You change lives and you get them the benefits that they've earned. That’s our reward,” Pierre said. “It doesn’t feel like work when you enjoy what you do.”



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