Jan 22, 2013

Social Security Slow In Responding To VA's Requests For Medical Records

     From Veterans’ Disability Benefits: Timely Processing Remains a Daunting Challenge:
Difficulties obtaining Social Security Administration (SSA) medical records, as one specific example, can also lengthen the evidence gathering phase. Currently, an interagency agreement exists that establishes the terms and conditions under which SSA discloses information to VA for use in determining eligibility for disability benefits, according to VBA [Veterans Benefits Administration] officials. Although VBA regional office staff have direct access to SSA benefits payment histories, they do not have direct access to medical records held by SSA. If a veteran submits a disability claim and reports receiving SSA disability benefits, VA is required to help the veteran obtain relevant federal records, including certain SSA medical records, to process the claim. VBA’s policy manual instructs claims staff to fax a request for medical information to SSA and if no reply is received, to wait 60 working days before sending a follow-up fax request. If a response to the follow-up request is not received after 30 days, the manual instructs claims staff to send an email request to an SSA liaison. VBA officials at four of the five regional offices we reviewed told us that when following this protocol, they have had difficulty obtaining SSA medical records in a timely fashion. Moreover, they reported having no contact information for SSA, beyond the fax number, to help process their requests. In complying with VA’s duty to assist requirement, VBA staff told us they continue trying to retrieve SSA records by sending follow-up fax requests until they receive the records or receive a response that the records do not exist. VBA area directors said some regional offices have established relationships with local SSA offices and have better results, but obtaining necessary SSA information has been an ongoing issue nationally. For example, officials at one regional office said a response from SSA regarding a medical records request can sometimes take more than a year to receive.
      For the most part, VA is pretty good about responding to my requests for medical records on my clients. However, getting records from VA's Regional Offices, where benefit determinations are made, can take time. Social Security rarely requests these records. I always ask for them as early as possible since it can take months to get them. It seems to me that the two agencies have the same problem. Their benefits adjudication processes are set up to adjudicate benefits, not respond to requests for medical records.

8 comments:

Anonymous said...

I am now retired from a DDS. Two decades ago, we always requested VA records and VARO records, but it took months to get anything and the claim was usually adjudicated without VA records. In the past few years, with the advent of eDIB and the VA's consolidated chart, the records come in blindinly fast but are very high volume (think 300 pages)to review with many notations about irrelevant care (dental work) or counseling the vet to quit smoking. Speed has improved but not substance.

Anonymous said...

agreed-I work in ODAR, and VA records have a bunch of pages at the beginning detailing each contact for a given period of time. Then the actual treatment notes start, but like the previous poster said there is so much duplicative/irrelevant information.

I try not to exaggerate, but it really seems as though for every 100 pages of VA treatment notes you get, 10 pages total might be relevant information. Their notes may be as bad as ophthalmology notes :(

Anonymous said...

I've reviewed cases with 700-800 pages of similar material from VA Medical Centers. It's just the way it is. However, the records from a VA Regional Office usually have the detailed medical assessments related to pension assessments. These are the most valuable and the hardest to get. If the assessment has already been done, the veteran might have a copy and this would speed things up.

Anonymous said...

Third post has good point about the vet being able to obtain his/her own records. A few decades ago,I had a claimant whose allegation was loss of 2 limbs. His only trmt. was VA. I called the vet and explained the situation re: obtaining records. He was going to the VA for an appt. the next day. A few days later he brought me records in person. In addition to the records, I was of course able to observe and report/record in file that he was indeed missing 2 limbs. It was one of the most timely and personally satisfying claims I adjudicated in my long career. It nearly made up for all the times I was screamed at and cursed by claimants I had to deny or cease.

Max Abilify said...

Anonymous four: What probably made your claim difficult to begin with was the observation by the interviewing claims rep of "no observable limitations" and a similar comment by the first CE physician.

Anonymous said...

Of course, with the push toward teleclaims and internet claims, absence of material observations will only increase.
Also, where are these requests for SSA records going? All SSA medical files since the end of 2006(NY State being the last) are electronic, and can be burned to CD and sent to VA in no time. Someone is dropping the ball, especially with the "Wounded Warrior" protocols.

Anonymous said...

Max--It has been too long for me to remember what or if the CR observed him in person. I think not because I would have tried to allow it based on that. My vague recollection (this happened 30+ years ago) is that he was an inpatient at the time of application. No CE was needed nor obtained.

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