On November 30, 2017, Veteran Esquire Legal Solutions, PLLC, filed four Freedom of Information Act (FOIA) Requests to the Veterans Health Administration (VHA). The requests were filed to obtain critical information regarding the VHA Clinical Appeals Process. The requests were filed to help Veterans and Veterans Advocates learn more about the process of appealing clinical decisions made by VHA doctors and healthcare providers.

Purpose of Requesting Information About VHA Clinical Appeals

VA doctors have significant power to affect the quality of life for Veterans receiving VA health benefits. VA Doctors can decide whether Veterans are eligible for thousands of dollars worth of additional benefits and equipment, such as caregiver benefits, allowances for adaptive equipment for automobiles, and grants to improve a Veteran’s home to accommodate service-connected disabilities. In addition, VA doctors have the power to make decisions that significantly affect a Veteran’s quality of life, such as deciding whether to withhold pain medication for patients with chronic pain, referring a Veteran to a recreational therapy program, or delaying surgery for a patient.

Veterans that are not satisfied with a VA doctor’s decision regarding a healthcare decision can appeal their doctor’s decision. However, there is limited information available about how veterans should file clinical appeals and how VHA processes clinical appeals. There are very few veterans law attorneys or VSOs that know and understand this system. Veterans deserve to have as much information as possible about this process that can significantly alter their quality of life.

Information Requested

Veteran Esquire Legal Solutions filed four separate FOIA requests to the Veteran Health Administration to uncover information about the VHA Clinical Appeals process. The requests seek to uncover the following information:

• Copies of each VA Medical Center’s official policy guidance on how to handle local VA clinical appeals
• Copies of training materials provided to VA employees, outside medical boards, and “independent expert reviewers” responsible for adjudicating VHA Clinical Appeals
• Specific data about the VHA Clinical Appeals process for fiscal years 2015-2017, such as the total number of clinical appeals filed, total number denied, total number granted, and average processing times
• All data reports produced by the computer program VHA uses to track clinical appeals nationwide

Veteran Esquire Legal Solutions believes this information should be publicly available and proactively disclosed on VHA’s website. Considering the lack of transparency in this area of veterans law, the firm hopes its efforts will help Veterans become better advocates for themselves when preparing VHA clinical appeals.

The FOIA Requires VHA to Respond in January 2017

Veteran Esquire Legal Solutions expects VHA to use all available time to respond to these requests. The FOIA affords VHA with up to thirty working days, or until January 16, 2018, to respond to these requests. Veteran Esquire Legal Solutions will continue to update you with the results of these requests.

Do you have experience with VHA Clinical Appeals? Tell us about it in the comments below. 

If you would like further information about these requests, or if you have a tip for a problem that needs to be investigated, please contact Veteran Esquire Legal Solutions today.