Retroactive pay: Timely, complex

Tom Philpott

Many Vietnam veterans with ischemic heart disease, Parkinson’s disease or B-cell leukemia expected VA compensation for their illnesses to begin soon after a 60-day congressional review period ended Oct. 30. Though the first batch of payments did go out mid-week, the relatively small number — about 1,300 claims worth $8 million — reinforced the fact that the process for calculating retroactive payments is timely and complex.

VA expects to produce a steady stream of rating decisions and payments each week for these diseases, perhaps in the thousands. But there will not be a November geyser of checks as some veterans had hoped. Most of 163,000 veterans or survivors with pending claims for these diseases should expect a longer wait, at least several more months. The VA goal is to have all these claims processed and paid by October next year.

After VA published its final regulation Aug. 31 to add these diseases to its list of ailments presumed caused by herbicide exposure in Vietnam, Congress had 60 days to block it. To veterans’ relief, it chose not to do so.

VA used that time to do preliminary work on many claims but had to stop short of assigning disability ratings. That’s because VA computers are programmed to assign a payment date with each rating and, by law, none of these claims could be paid before the 60 days had passed.

Claim specialists don’t have all the information they need yet to rate a lot of the old claims. Many veterans and survivors in line for retroactive payments, some going back 25 years, are being asked to provide letters from private physicians explaining when the ailments first were diagnosed.

VA also will try to develop timelines for a disease’s progression in individuals so appropriate disability ratings can be assigned at different stages, and back payments are calculated as accurately as possible.

For ischemic heart disease, for example, a patient initially needing medication might have been rated 10 percent. Years later, when an x-ray showed an enlarged heart, the rating could have been raised 30 percent. As stress tests showed the disease progressing, higher ratings and higher compensation would be made.

More than 1,000 claim specialists in nine VA resource centers are working solely on 93,000 claims filed for these diseases between Sept. 25, 1985, and Oct. 13, 2009. The end date is when VA Secretary Eric Shinseki announced his decision to add these diseases to the list of presumptive diseases for Agent Orange exposure.

The earlier date is when VA first published a regulation on presumptive AO diseases, sparking a successful court challenge on behalf ailing Vietnam vets. This resulted in an appeals court ruling, Nehmer v. Department of Veterans Affairs, ordering that VA compensate veterans retroactively for any claim they filed for a disease later deemed service-connected because of new medical evidence linking it to herbicide exposure in Vietnam.

Shinseki’s announcement triggered Nehmer protection for 93,000 previously denied claims. Since then, 70,000 more veterans and survivors have filed new claims for these diseases. The more recent claims are being worked at VA regional offices by another army of claim specialists.

VA officials know their computer runs haven’t identified all previously denied claims for these diseases. The fault lies with a legacy data system, the Benefit Delivery Network. It was programmed to retain only six conditions claimed by a veteran. So if a veteran claimed 10 ailments, four of them, once denied, would not be found today in the electronic record. The lost conditions could include one of the diseases now deemed compensable.