The VA's Use of Provisional Ratings to Reduce the Disability Backlog
The VA has suspended this program as of November 11, 2013.
For a time, veterans whose initial applications for VA disability compensation were languishing for more than a year could benefit from an initiative by the Department of Veterans Affairs (VA) to address the claims backlog. This initiative took effect on April 19, 2013. The intent was for the backlog to be cleared up by 2015. Some veterans benefited from this initiative while others weren't not be helped (and could possibly have been harmed) by the backlog reduction.
Veterans With Existing Claims
The veterans who will benefit the most from the new program will be those who have been waiting the longest for a decision on their disability compensation claims. Priority in processing will be given to these oldest claims first. Thus, a veteran who has been waiting 18 months can expect to now be given higher priority than a veteran who has been waiting 12 months. There are currently about 250,000 claims from veterans who have been waiting more than a year for a decision, out of a total of 800,000 pending claims.
Veterans With New or Recent Applications
Veterans who have recently filed applications or who will be filing soon will not benefit from this program. In fact, for a time, newer applications will be even further delayed in processing while the backlog of long-languishing claims is attended to. The current average processing time for a disability claim is 286 days.
However, veterans submitting fully developed claims under the VA Fast Track program will continue to receive priority in claims processing even while the new initiative is underway. And other groups of vets, such as Medal of Honor recipients, former POWs, terminally ill veterans, and vets with severe financial hardship, will continue to receive priority in claims processing.
The VA hopes that as the backlog is diminished and the new paperless processing system is instituted in all regional offices, newer claims will be decided much more quickly than in the past.
Use of Provisional Ratings
To expedite processing and reduce the backlog, this new program requires the VA to assign a "provisional" (temporary) rating to all claims deemed eligible for benefits. This rating will not be finalized by the VA for one year, but during that year, veterans can receive the full disability compensation amount that the rating merits. (Read Nolo’s article on VA disability ratings to learn how ratings translate to dollar amounts.)
In assigning the appropriate provisional rating for a disability, the VA will consider the evidence currently on file. This means provisional ratings will sometimes be issued based on incomplete files. The idea is that the evidence can be more fully developed during the one year period following the issuance of the provisional rating.
For example, if a VA medical examination is required to fully develop medical evidence for a claim, such an examination will be ordered after the provisional rating is issued. (In some cases, however, the VA has said that a medical exam may be required before a provisional rating is assigned.)
Submitting New Medical Evidence
Veterans can continue to submit new medical evidence for a year after the provisional rating is assigned, until the VA finalizes the rating. When veterans submit new medical evidence, the VA intends to fast track the processing. This could help veterans get increased ratings, and a larger monthly benefit check, more quickly.
Retroactive Rating Increases
If, after evaluating new medical evidence that the veteran submitted, the VA finds that a rating increase is warranted, the increased rating will be effective back to the date the claim was first filed. This means a veteran could receive a retroactive payment for the increased rating back to the original date of application.
Appealing a Rating
Veterans may not appeal a provisional rating; they must wait until the VA makes the final ratings decision (but veterans can submit new evidence to the VA up until the finalized rating is released).
After the VA issues a decision finalizing the provisional rating, a veteran will have all the same rights of appeal that normally apply after issuance of a ratings decision. For more information, see Nolo’s article on appealing a veterans disability rating.