At VAC Red Zone applications are triaged for priority adjudication due to medical risk, and less often, financial risk. An approved Red Zone request is typically decided within seven to ten business days.
When a Veteran was diagnosed with end-of life heart failure attributed to their service, the Veteran’s Red Zone request (as they were medically at risk of death), was approved. A year after undergoing surgery and receiving treatment for their heart failure condition, the Veteran applied for disability benefits for two conditions related to the heart failure. Their request to have these applications Red Zoned was denied. VAC’s decision was based on the fact that the Veteran had recently received surgery and was currently receiving treatment for their heart condition and was therefore not currently medically at risk for death. However, the client explained to VAC that while the surgery was lifesaving, their conditions were still considered end-of-life, as they were irreversible. Having no appeal options available, because the decision to apply a Red Zone criterion is done solely at the discretion of VAC, the Veteran contacted the OVO.
Upon review of their case, the OVO determined that denying the Veteran’s request to Red Zone his new applications was unfair because the policy does not state that if a Veteran pursues treatment, they are no longer considered end-of-life.
At the request of the OVO, the decision maker sought a second opinion from a VAC Nurse Adjudicator. The adjudicator’s opinion was that although the Veteran’s condition is now stabilized because of surgery and medication, it could deteriorate very quickly, and they still met the threshold for being medically at risk. This resulted in their Red Zone request for two disability applications being approved.
