VA Claim Deferred: What This Means and What to Do
After filing an initial VA disability claim, veterans wait for a decision from a VA Regional Office. Importantly, this decision could involve a grant, denial, or deferral of benefits. While grants and denials are rather straightforward, deferred VA claims tend to be less well known, and therefore, less understood.
What is a VA Claim Deferral?
Generally speaking, a deferred Rating Decision is issued when the veteran’s claim is either underdeveloped (i.e., lacks the evidence necessary to make a decision) or incomplete. As such, a deferral is neither an approval nor a denial. Instead, by issuing a deferral, the United States Department of Veterans Affairs is essentially placing a hold on your claim and requiring further development to be completed before making a decision.
Why Does VA Issue Deferrals?
Again, a deferred decision means VA lacks all of the evidence necessary to make a decision. At this point, VA will try to obtain the information it needs in order to issue a new decision either granting or denying benefits. In certain cases, VA might ask veterans to obtain and provide the necessary additional information. Overall, VA will only defer claims if they need to be fully developed before moving forward.
VA may also defer veterans’ claims if they are based on multiple service-connected conditions. In this case, VA might have enough evidence regarding some of your service-connected conditions and their impact on your daily functioning, but not others. As a result, a deferral is issued in order to gather the required information for those specific conditions.
What to Do After Your VA Claim is Deferred
A deferral can be seen as a stepping stone to a new decision. This process begins with VA notifying you that your claim has been deferred, typically in a Rating Decision from your local Regional Office. In this decision, VA should identify the reason for the deferral. From there, VA will take the necessary steps to further develop your claim or instruct the veteran what information it needs.
Additionally, you might submit further evidence in support of your claim at that time. Once this process is complete, VA will issue a new decision. Importantly, if VA does request certain information that you are unable to provide, it may issue a decision based on the information that is available.
Deferred Claims vs. Confirmed and Continued Claims
Rather than a deferred claim, it is possible that VA will issue a decision that says confirmed and continued. This typically occurs when veterans have already submitted additional information, but VA determines such information is not persuasive or it is not “new and relevant”. Here, “new” means that the evidence must not have been of record at the time VA was previously reviewing the claim, and “relevant” tends to prove or disprove an issue related to the veteran’s claim. Essentially, a confirmed and continued decision from VA means you need different evidence whereas a deferred decision means you need more evidence.
VA Issued Thousands of Improper Deferrals on VA Claims: OIG Report
On May 15, 2019, the Office of Inspector General (OIG) released its report: “Deferrals in the Veterans Benefits Management System (VBMS)”. In VBMS, there is a distinction between avoidable and unavoidable deferrals. Specifically, the former occurs when claims processors incorrectly determine a claim is ready for decision whereas the latter are caused by actions outside of the claims processor’s control, such as receipt of records after the claim was made ready for decision.
Avoidable deferrals are assigned to the Regional Office that caused the deferral while the unavoidable deferrals are assigned to any Regional Office based on claim priority and production capacity. Claims processors who receive a deferral are required to resolve it within five business days.
What the Report Found
OIG analyzed a total of 116,000 deferrals issued between February and April of 2018. Again, unwarranted deferrals refer to when part or all of the deferral was not necessary and claims processing could have continued without rework. Within the 3-month review period, 23,200 out of 116,000 deferrals (20%) were unwarranted. OIG found that unwarranted deferrals could result in needless examination costs, delayed processing, unnecessary rework, and improper guidance to claims processors. Specifically, an estimated 7,000 unwarranted deferrals resulted in avoidable medical examinations.
Based on the rates at the time of the review, the OIG team estimated that VBA could spend at least $8.8 million on unnecessary medical examinations taken over the next five years if corrective actions are not taken. Furthermore, of the 23,200 unwarranted deferrals, 16,200 (70%) were delayed. Delays averaged 43 days with the longest delay being 232 days.
Ultimately, OIG concluded that VBA staff need to improve accuracy when creating deferrals in order to minimize unnecessary medical examinations, claims processing delays, incorrect instructions provided to claims processors, and unreliable tracking data used to train staff.
