$40 Million In Improper Payments Due To Hickey’s Provisional Rating Scheme

Provisional Rating Scheme

Benjamin KrauseAgency watchdog VA OIG found the agency failed to accurately rate 32 percent of ratings due to Under Secretary Allison Hickey‘s provisional rating scheme. This inaccuracy caused over $40 million in estimated improper payments – which are defined as either underpayments or overpayments. VA OIG estimates VA staff did not accurately rate 17,600 of 56,500 claims processed.

[Read the VA OIG Report]

Agency workers claimed pressure from the tight deadline caused them to make the improper ratings within the 60-day rating window.

In April 2013, due to mounting pressure from the growing backlog, Under Secretary Allison Hickey made a bold move to provisionally rate veterans whose claims were stuck in the backlog. The provisional rating scheme allowed for temporary rating decisions for claims pending over 2 years. On the surface this sounded good to many, but like most things VA tries, the agency was unable to properly implement the policy and veterans were harmed economically.

Will they ever get it right? Or, is it time we rid ourselves of the Pentagon blue blood newly retired generals that move seamlessly into its ranks in favor of more properly equipped corporate reformers?

Hickey’s makeshift policy led to misrepresentations of backlog numbers by the Veterans Benefits Administration in a multitude of ways, but one trick in particular really stood out. According to VA OIG:

For example, in one case, VARO staff at one facility completed a provisional rating, denying one issue while they waited for additional evidence. They closed the claim with the provisional rating. The VARO took credit for completing this claim in 806 days. VBA also no longer considered this veteran to have a rating claim pending while the VARO waited for required evidence to support the one provisionally-denied issue. Upon receiving the additional evidence, VARO staff established another rating claim, which they reported completing in 1 day after they issued a final rating. However, this veteran actually waited a total of 901 days to receive a final decision on the entire claim.

After just six months, VA finance nerds realized the plan would deplete its budget quicker than expected. You see, if VA paid all backlogged claims at once, it would result in billions in back pay immediately paid out of agency coffers that were unanticipated the previous year. This would send controllers at the Treasury squealing and other government programs would get stilted.

Do you see how that works? VA did not anticipate solving the backlog quickly because of the cost to the Treasury, not because it was unable to resolve the problem. When the coffers were depleted, the program was halted.

At the end of the day, the policy did not result in quicker payouts despite the earlier claim from Under Secretary Hickey, “Issuing provisional decisions not only provides veterans with applicable benefits much more quickly, but also gives them an additional one-year safety net to submit further evidence should it become available.” Director of Compensation, Tom Murphy, also echoed this sentiment.

Instead, the initiative merely served to artificially reduce the backlog numbers when it was politically expedient to do so. Despite the hype, when asked, Mr. Murphy was unable to cite one scenario where provisional ratings were more efficient than the existing standard.

According to VA OIG, in the end, veterans were economically harmed by the scheme while Veterans Benefits Administration was able to remove some political heat for a little while.


Read More: https://www.va.gov/oig/pubs/VAOIG-13-03699-209.pdf



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  1. It is a sad state of affairs when you get denied a back claim, “lots of doctors notes included for simple comprehension purposes since this behoves them in the first place-no date on my active duty 3 pieces of paper one a discharge paper- date stated, “January 1981,” which also stated “DVA.” ( code for yes, go to the VA for a rating, I had this discharge physical done quickly, no time for a medical board, dare I say could easily win? But when they commit fraud, by lying and answering the questions you answered, it because, “waste” your tax dollars to keep the spin cycle of jobs going, then “abuse” because they have overstepped the boundaries within their ability to practice correctly and give some B.S., DSM VIIR excuse-just FYI, you really can’t do that in a short period of time, and truthfully she should have asked a few more in-depth questions to get a “proper view” of my responses. Just FYI- they play a game, the game is a letter, the letter states it will take us longer because you have several claims-LIARS CLUB ANYONE? Less than one month later, I get that letter, and since it is hard for me to do easy tasks-“such as stated, a bit OCD since I can’t clean, and a hereditary traits. A joke, because pretty much all of us females in my family had it. It drove my mom nuts to visit and see the sink had dishes in it, “I stated, when it’s time after dinner, the kids clean up,” it drove her nuts! 🙂 funny in a way, but what I deemed important was not dishes, broken or not, just be happy!
    I use the analogy of my moms not being able to understand, they didn’t rush to put in the dishwasher right away, as to WACO, TX using a game to make you believe their B.S., they spew all over the place. Oh, for shame, because I couldn’t up load my documents with the notes all over the damn pages of “FRAUD, WASTE AND ABUSE, I instead wrote a letter, it took no issue to load up! I stated, the person who did my C&P claim, “lady, I can’t fake my back crap, the ct-scan ( no contrast was suppose to be with both) showed, “why yes! She really does have a damn big problem!” Care to tell me no date again? Care to answer my questions for me as well? I do not bring certain family members into the mix, for a good damn reason, nor should I have to. ( which FYI I asked for a cd copy of my spine, “why are people so damn rude? I can get a copy for my own records period! But this seriously was for my doctor of 19 years so he could have copies of their so called B.S., treatment from the start.
    I suggest, medical records keep a copy of. Please do not annoy me by stating “one must print the who thing for one paper!” Because “knowing EMR OR EHR” depending where you live, it brings up the page, push a button for that page, all done! But, I figure the VA hasn’t trained it’s staff, gee and anyone should be surprised as to how or why?
    Oh, I will be returning my back claim, with the abnormal results, again sending my very clear comprehension notes, (,seems to be an issue here) along with my discharge paper, and my DD-214 from that time. And may they all become “beavers in building dams since I see no other damn use or then period!
    I must say so, “I just love the paper work reduction act-two huge damn bags full of reduction my ass act. I am just tempted to take a picture, write POTUS, and ask, “is this a paper work reduction act you’re working on? Just curious, replant the trees POTUS, HEMP HAS NUMEROUS UESES, ONE BEING TO CREATE PAPER! ( no I am not endorsing hemp to smoke-it belongs in the same family, just “google it!”

    You are entitled to your VA records and don’t have to provide an answer period! I would say when done if they give you hell”-GET STUFFED!” And if it is for an outside provider-let them make copies, but keep the rest! 🙂
    Regional Offices Investigations Have Commence! Let us see where all that damn money was spent on!

  2. Ahhh, the Provisional Denials…
    I espoused the same sentiment as the author, a year ago when they began…
    I wrote letters to all of my Congressional Representatives, ALL service organizations and even the President.
    I explained to them that this Provisional plan was just smoke and mirrors to place long waiting Vets on an invisible list and take them off the backlog. No one listened…
    I have been waiting since 6/2011 for a rating. The provisional rating I received from an alternate RO omitted my request for an increase to my service connected back condition, and denied all other contentions.
    The wording was contradictive… stating that my service record shows that I suffered injury in service and then in next sentence it states there was no link to service… My guess is that it was merely a form letter. The rating also stated that I needed to have 2 exams to complete but I have yet to be scheduled.
    I just passed the 1 yr mark since receiving the Provisional, I have had no exams and I have never heard from my VARO either. On ebennies the “appeal” link has disappeared on the closed provisional claim but the claim with same date says “Administrative Review” I am at a loss gents…
    Where do we go from here?

    1. Hello Brian, there are many things that you need to do. Do you have your C-file (claims)? Do you have a Service Officer? Do you have all of the actual (paper) medical files from any VA Hospital you have been seen at? If you don’t have your C-file, get it. Read every page that is in it and see what is in there and what is not. Get a service officer that you feel as if they will put some effort into helping you. Some just seem to think that they are there to breathe air. Get all of you paper medical records (you can request them from other VA facilities that you have been treated at). Some people say that the stuff you can download from the Ehealth site will give you everything you need. They are wrong. My paper reports have things in there that are not in my downloaded version (why do you think they have the “Three day waiting period”, to leave out somethings. Read all of that. Does it show that you have been treated by a Dr. for your back and the Dr. has noted it was from your service accident? See how many times you have been treated for it. If you have only been seen once and nothing was done, then you will most likely not have much in your favor. If they have done other things on your back (X-rays that show something, MRI’s, ETC…) that is good for you. YOU will have to do most of the work if you want to have a chance. This is your claim and unless you trust someone else to handle it for you then you will have to do the work (I wanted to make sure that I won my case and I was still unsure until the end).
      If they send you to an exam and it is not what it should be, then complain, complain, and complain some more. They want you to just give up so that they don’t have to award you what you deserve. I have had exams that I waited longer in the waiting room than in the exam. Get a copy of the exam. make a copy of the paperwork they send you if you have to answer anything. Always make a copy and keep it for your self. My first exam the Dr. changed the answers right in front of me and made it sound as if I was not as bad as I was. I complained and used that in my favor. I had to fight for six years now and I still have a couple of things they are looking at. I went from 20% to 40% and received over $9,700.00 in back pay and I am waiting for the other par to be finished. Call the number on the Ebenifits ombudsman and see what is going on. You still may have a claim that is open, it may not show up on that site. That site has glitches sometimes. Just get ready to do some work if you feel it is worth it and will get you the rating (even a zero percent means they acknowledge you have a disability) you deserve. Call the VA you go to and explain to them that you are to have 2 exams and need to schedule them. Don’t wait on them, they’ll never call. Find your VARO office number (the actual one for your region) and call them (they will not call you first as they have no incentive to call. They make the same $$ if they call you or not and most will not put forth the effort). The only thing going against or may help is the one year time limit. You may have to re-open the claim and that will give you a chance to get all of the above in order to get your award and it may take a few years. I hope this helps.

      1. I should have said “keep the originals of any paperwork and send in the copies”. The original is the actual paperwork ans will show no doctoring it up if that is questioned Just like in a court of law they want to see the original).

      2. I should have said “KEEP THE ORIGINALS AND SEND IN COPIES OF THE PAPERWORK”. It is just like a court of law and the originals will show that the paperwork has not been changed if that is ever questioned. Sorry about that, my fault.

  3. “Brothers” You Ain`t seen nuthin Yet, I`ve been begging for 43 Years. I do get a 225.00 Pension because I don`t get but, 800.00 Social Security. I`m stuck in a wheelchair, Live alone. I have`nt left my property in 8 mo. A “Friend” Shops for me if I`ll buy him a case of beer. Me, I don`t Drink, But I eat, Maybe that`s why i`m always broke from the 4th til the 3rd.
    I`ve had an appeal for at least a year, It`s “NEVER MOVED” it`s says it`s Current,- Pending. (The First stage, of five or six Stages). I`ll be dead before it get`s to a V.A. Judge.
    BUT, DON`T QUIT, Maybe it will change soon. If my appeal out lives me, I STILL WANT YOU TO GET YOURS. At least they will help “Some of us”, Sooner or Later.
    Until we stop being Numbers, And START being “Human Beings” to these people. There`s a LINE that gets L-O-N-G–E-R By the Day. We`re not Dieing Fast enough for it to catch up.
    Good Luck & God Bless you all, Thank you for your Service to our Country. (I`m not getting Paid to say that, It`s a requirement at the V.A.) I Mean it.

    1. Curtis, you gave me an idea. I don’t know where you live but I feel that if some of us other disabled vets who have been through this before can contact Curtis (or another vet in need or is “lost” in this screwed up system, we can give them info or some help in getting their clams going or continuing). We can help one another and put this disability system on its ear. They will not know what hit them when they start getting vets that have applied for disability and have all the proof to get them an award they deserve.
      I know some of you will say that is what we have Service Officers for. Here is my thought on Service officers. They make X dollars a week, a month, a year. They make X dollars if they get one case approved or a million cases approved. They also make X dollars a week, month, or year if they get ZERO cases approved. What is their incentive to help us in getting an increase. NONE. they are not going to try and go above what they need to do between 9am to 5pm. My current Service officer has not one clue as to what is going on. She will call me and tell me she is returning my call and wants to know what she can do to help me. The problem is that I have not called her in weeks. She just calls me. I tell her that I have not called and we get into a super weird discussion that she tells me that if I am going to go above the VBA then they (the VFW) will no longer be able to do anything to help me. I say “then why are we talking” and she stars going on about reports that are over a year old and have no bearing on the case. I have done all the hard work and found what I need and have shown it to her so she can see what I am wanting. I could just set back and put it in her hands to get the approval that I am sure I would not have gotten. (from 20% to 40% and I am still waiting for I think another 20%) Anyway that is getting off the subject. I just think that we vets who have been through this stupid system know what needs to be done and what needs to be left out. You can still have a Service Officer just don’t let him know about this and other vets can will just as we have done. I will be willing to help anyone who is close to me and we can get into the paperwork needed to make it legal (I know some people who practice in the law field and would help make sure we can do things legally). I want other vets to know that they are not fighting this system alone and can have someone to help explain what is going on and can look into their records ( with the proper legal papers signed) and know what will help them and can show them what is happening with this , that or whatever. What do other vets think of this. We need something like this to help our fellow vets who have no idea what is going on and they just except the denial letter when they have the proof in black and white, it was not sent with the other paperwork. I am for it. I want to see more of us win against this evil system that is doing everything it can do to screw us over. Time for revenge. This is just my opinion and my thoughts. Nothing may become of this. I am willing to try and see what we can do.

  4. My last C & P exam the DR. put that I now have a limitation of 10 degrees extension in both of my knees and arthritis in my left ( I have always had a 0 degree extension in both knees until this exam and it is in my medical files as zero degrees) and some other things in the right. I was approved for the limitation in the right knee and not the left. I did not get approval for the X-ray proof of the arthritis on the left. In fact I was denied for every thing on my left knee but approved on my right even though I had the same results at the same test at the same time and had x-rays done on the same day as the exam. I had been fighting this for six years now and I don’t understand how they can approve you for something in just one knee when it was found in both knees and I an currently rated for both knees (before the latest exam) but this is pure BS. Approved in the right knee but denied in the left knee. It doesn’t make any sense. I have sent them the notes of the exam and explained to them about this is the result in both knees so how can you deny the left and deny the arthritis in the left. I see that on Ebenifits it has been kicked back and forth from the VSO to the VLJ so hopefully they will see the mistake and fix it.
    I think that just because they sent me over $9,000.00 I would say OK and there would be no more. The problem was that they already sent that money and gave me a year so I have used their generous offer to show them that they owe me more. I will not give-up until they see it the right way (not my way). They owe and they will pay. It’s all in black and white. I even have a Dr. that put in my notes from a year ago that I have x-ray proof that I have arthritis in BOTH KNEES. Yes I sent that one in as well. Anything that helps my part they received. I made sure to keep the paperwork to a small amount ant get right to the point so they would not see a bunch of papers and just think that is too many so we will deny it. they have the proof, the dates, and the actual words from the Dr. We will see. If I lose, then I will appeal it (above the VBA) as I know the this is wrong and it needs to be made right.

  5. Ben is justified in his worry that the focus of the VA scandal is shifting from the nation’s attention.

    But it ain’t no accident.

    In order to make room on military bases throughout the United States for the hundreds of thousands of incoming alien invaders on our southern border, Obama has ordered pink slips to be given to tens of thousands of U.S. soldiers while they are still actively engage in combat in military theaters of operation overseas.


    Right now, the nation’s attention is primarily focused on the illegal aliens invading our hometowns.

    This border invasion is happening for ONE REASON – TO DISTRACT VOTERS from the scandals at the VA which are directly linked to Obama.


    Like I ALWAYS WRITE in my comments here, the ONLY WAY the VA is going to get better for us disabled veterans is for us to STOP VOTING for politicians like Bush, Obama, and Clinton, who have a long history of using our troops and us disabled veterans as political hostages to whatever current crisis they contrived in their agenda for more power.


  6. Exactly, my last trip to the RO I remember telling the employees who were giving me the runaround that I never once said no to a job, task, operation, deployment, training, order, command ever in my 11 years of service why would they say no to me now? It might have sunk in because every employee in the office stopped, looked at me and thought….they then went back to work helping the VETERANS behind me out.

    1. Irregardless the VA isn’t going to change much and the claims process will continue to be a bullshit standstill because the issue is that people working the claims and medical departments have no idea what a military person does in the military on a normal day, let alone on a special day of heavy combat or in a run up operation or in preparation for an operation etc. I went through my C-FILE yesterday and realized that had the VA properly looked through my medical and service records upon existing the military there would’ve been no need for proving any injury incurred for any previous, present or future claims for service connection and my life would’ve taken a totally different course and I wouldn’t have known homelessness, or hunger. I wouldn’t have had to do half the foolish things I did in my life after service to survive and live. The solutions are simple but getting the VA to solve the problems are complicated when there is no proper oversight and funding. The problem with the VA directly correlates to the problems in Congress and the Senate and if we stop getting the American taxpayers on our side we lose! Thus we must yell louder and harder to the American taxpayers for help if we are to get a better VA SYSTEM.


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