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KARE 11 Investigates: Ignored warnings result in Veterans denied benefits

Despite a direct appeal by veterans’ advocates to President Trump, VA ended a review process that might have prevented thousands of mistaken denials during pandemic.

WASHINGTON, D.C., USA — “You’re kind of lost in the sauce,” said frustrated United States Marine Corps Veteran Benjamin Juarez after receiving a benefits denial letter from the Department of Veterans Affairs. It claimed he failed to show up for a required VA exam.

“Did you miss that exam?” asked KARE 11 investigative reporter A.J. Lagoe.

“I missed it because they told me not to attend it,” Juarez said – laughing at the absurdity of the situation.

Juarez is just one of the Veterans KARE 11 found who were wrongly denied benefits for missing an appointment the VA itself had already cancelled due to the COVID-19 crisis.

Veterans advocates say errors like that might have been prevented if the VA had not abruptly ended a decades-old practice of giving veterans service representatives 48 hours to review benefits decisions for accuracy before they became final and are sent to veterans.

The VA’s decision came despite a direct appeal by veterans groups to President Trump to block it.

In the wake of the policy change, sources tell KARE 11 that thousands of Veterans nationwide may have been wrongly denied benefits.

A broken promise

Juarez, of San Diego, California, is one of thousands of Veterans who had disability claims pending with the VA when the COVID-19 pandemic struck the nation in force in March.

Credit: KARE 11
Marine veteran Ben Juarez was denied benefits for missing an appointment the VA itself had cancelled.

He had been scheduled for an in-person Compensation and Pension (C&P) exam with a VA medical contractor in April, according to medical records he shared with KARE 11.

However, before his scheduled appointment a KARE 11 investigation exposed how Veterans were being told to report to in-person exams – even to exams in hard-hit New York City – as the coronavirus crisis worsened.

Veterans said they should not be forced to choose between the risk of exposure to the coronavirus and having their benefits claims denied or drastically reduced.

On April 3, VA ordered that in-person benefits exams be cancelled due to health risks during the coronavirus crisis.

Veterans were promised on the VA website that, “We won’t deny a claim solely for failure to report for an exam at this time.”

Juarez says he is living proof the VA didn’t keep its promise.

It happened in part, according to veterans advocates, because both VA Secretary Robert Wilkie and President Trump ignored warnings about what would happen if they ended a critical checks and balances policy.

The 48 Hour Review

In April, in the midst of the coronavirus crisis, the VA stopped its long-standing practice of giving accredited veteran service representatives 48 hours to review benefits decisions for accuracy before the decisions became final.

Before that change was made, the nation’s largest veteran service organizations (VSOs) and members of Congress in a bipartisan letter argued that ending the 48-hour review would result in delays, create confusion, and undermine a veteran’s right to competent representation when applying for VA benefits.

“The 48 review is extremely important,” said Ron Quade, the Director of Claims and Field Operations for the Minnesota Dept. of Veterans Affairs (MDVA).

MDVA is the local state agency that helps Minnesota veterans navigate the complex VA claims process.

Credit: KARE 11
Ron Quade says advocates used the 48-hour review to spot mistakes before the VA issued denials.

“On a regular basis we find even simple errors that we can help the VA with,” Quade explained.

Veterans of Foreign Wars (VFW) was the first agency to raise the red flag.

Back in March, VFW National Commander William “Doc” Schmitz denounced as “despicable” and “inconceivable” that Department of Veterans Affairs Undersecretary for Benefits Dr. Paul Lawrence intended to eliminate the 48-hour review period.

In a late March news release, Schmitz said, “Making this change in the midst of a national pandemic is extremely troublesome and is just the latest example of distrust and lack of confidence in our VA to make our veterans its number one priority."

The VA has not responded to KARE 11’s questions about why they cancelled the 48-hour review period.

However, VFW staffers tell KARE 11 that VA officials told them the decision to eliminate the review window was made because its online claims system, established in 2013, made the process "obsolete."

The VSO’s representing millions of former service members, their families and survivors wrote letters to VA Secretary Robert Wilkie urging him to reconsider.

They even wrote directly to President Trump calling on him to order VA not to do away with the 48-hour review period.

The VA made the change anyway.

Bizarre Denials 

Within weeks of the VA ending the 48-hour review period, KARE 11 began hearing from Veterans around the country claiming they’d been unfairly denied benefits.

“That’s a total lie!” said angry Texas veteran Harry Payne. He had received a benefits denial letter from the VA claiming he failed to show up for a required exam that VA itself had cancelled due to the COVID-19 pandemic.

“The VA sent me a letter saying my claim was denied,” the 21-year veteran said when he reached out to KARE 11 Investigates asking for help. “And then you read the reason why, and I get even madder because it’s a flat out lie!”

At the time, KARE 11 was told Payne’s case was “an anomaly” and the VA staff involved with issuing his benefits denial were “being retrained.”

However, other veterans continued to contact KARE 11 asking for help after receiving similar denials.

“It’s not right, and I’m not taking this lying down!” said Vietnam era Army medic James Wood of West Virginia.

All of the veterans KARE 11 spoke with say when they contacted the VA about the obvious mistake, they were told they would need to appeal the decision.

“It’s just kind of frustrating” said Juarez, “because you have to go back to – almost feels like you have to go to the back of the line and restart all over again.”

Appeals can take years, and these sorts of delays are exactly what advocates warned would happen if the 48-hour review was eliminated and veterans’ representatives lost the ability to review the claims decisions before they are finalized.

"It unavoidably causes delays in the process” said Quade with MDVA. “Sometimes those delays can be months or years.”

Matthew Doyle, VFW national legislative service associate director pointed straight at the VA’s decision to cut out the 48-hour review during a May 27 Congressional forum.

Doyle said before the VA policy change went into effect, VFW service officers had caught a Rating Decision where a Veteran was denied for missing an already cancelled exam.

“The VFW was thankfully able to intervene and have the exams reordered and held until a later date,” Doyle said. “Since the elimination of 48-hour review, Veterans will now receive these kinds of erroneous decisions and have to file more paperwork to fix this problem,” he added.

A Thumb in the Eye

Members of both bodies of Congress expressed dismay over the wrongful denials exposed by KARE 11.

“We should not allow a single veteran’s claim to fall through the cracks during this pandemic,” said Congresswoman Elaine Luria, (D-VA) Chair of the House Veterans' Affairs Subcommittee on Disability Assistance during the Congressional forum.

“Now you tell me, that don’t even make sense!” exclaimed U.S. Senator Joe Manchin of West Virginia. “That’s when we say C’mon!”

Credit: KARE 11
Sen. Joe Manchin has introduced a bill to restore the 48-hour review system.

“We’ll get this corrected,” Manchin told KARE 11 during a May interview, “I really believe we will.”

A few days later, Manchin and a group of Democratic Senators introduced legislation to restore the 48-hour review process. Under the legislation, VSOs, as well as attorneys and claims agents, would be permitted to review benefits decisions before they are final.

“VA’s recent move to eliminate the 48-hour review rule is a thumb in the eye to any veteran relying on professional assistance to navigate the complicated claims review process, especially during this trying time,” Senator Jon Tester of Montana said in a statement.

Denials Reviewed

The VA itself has launched a review of all benefits claimed denied during the COVID-19 pandemic based on the veteran allegedly missing their exam.

“This is a priority for VBA, (Veterans Benefits Administration)” said spokesperson Randal Noller, “and we are working to get it done as quickly as possible.”

Approximately 18,000 claims have been denied because of missed exams since the start of the pandemic, according to Congressional staffers who spoke to KARE 11 after being briefed on the ongoing investigation. They say the VA will start reviewing those cases to check for accuracy next week.

After this report was initially published, Noller, the VA spokesperson, emailed to state that not all of the 18,000 claims under review were denied due to missed exams. 

“VA’s review is very broad out of an abundance of caution and will include Veterans that were not affected to ensure that no one was negatively impacted,” he wrote.

VA says if a Veteran believes they were wrongly denied for missing an already cancelled exam, they should contact the Veterans Benefits Administration at 800-827-1000.

After KARE 11 flagged Benjamin Juarez’s bad denial to VA and the House Veterans Affairs Committee, Juarez had his denial overturned and was rescheduled for an upcoming tele-appointment.

If you’re one of the Veterans impacted by VA scheduling benefits exams during the COVID-19 crisis, contact the team working on this investigation at: investigations@kare11.com

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