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VA: Broken claims system can't be fixed

VA: Broken claims system can't be fixed
Craig Roberts

Given the tenor of their testimony scripts, many of the veterans' advocates at the March 18 "2010 Claims Summit" on Capitol Hill were loaded for bear. Representatives of 49 veterans service organizations and veterans interest groups had gathered before members of the House Veterans Affairs Committee to express a mixture of admonishment and frustration at the Department of Veterans Affairs' infamous benefits claims backlog - a backlog that has veterans waiting, in some cases, for years to receive what they believe is their due.

But, Committee Chairman Bob Filner, D-Calif., redirected the group's focus up front, declaring the meeting to be "about solutions" not rehashing the problems that represent, in his words, "an insult to our nation's veterans." Thus, what was to have been a strictly orderly but, perhaps, redundant and not altogether substantive series of two-minute mini-speeches became a more free-wheeling exchange of ideas with the common goal of eliminating, or at least alleviating, the claims logjam. At last count, the number of unresolved claims being processed by VA topped 1 million and was growing.

Filner opened the mid-afternoon session with a couple of thought pieces. He proposed that the service-connected claims of all Vietnam combat vets be honored automatically, and wondered aloud why the VA doesn't model itself after the new kinder and gentler Internal Revenue Service and award benefits "subject to audit" as the IRS issues refund checks. He then turned to Rep. John Hall, D-N.Y., chairman of the House Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs, who declared strongly that it was high time the Obama administration appoint a permanent Veterans Benefits Administration under secretary to corral forces in meeting the claims backlog challenge.

With that, Filner threw the floor open to discussion. Common themes were soon identified: the claims backlog is huge and, seemingly, growing exponentially, and, policies and procedures within the VA hinder the prompt and final adjudication of claims.

A Promise ReiteratedDuring the recent 50th Annual Washington Conference, VA Secretary Eric Shinseki told Legionnaires that eliminating the claims backlog by the year 2015 is among his top priorities. He explained the rapid increase in outstanding claims by noting the acceptance of Agent Orange exposure-related diseases and conditions as grounds for filing. This will be adding 200,000 or more claims to the pile, VA said.

During his Washington Conference appearance, Shinseki indicated that he is pinning his hopes on the implementation of the VLER (Virtual Lifetime Electronic Records) program developed jointly by VA and Department of Defense. The employment of instantly obtainable and transferable computer records that will follow a servicemember from swearing-in through retirement, intimated the secretary, will streamline the benefits awards process to the point of eventually eliminating a claims backlog.

VA officials testifying at the claims summit reiterated Shinseki's pledge, detailed it and expanded upon it. The VA's defense against a large roomful of constructive critics began with a statement that some found startling and others found refreshing and promising. "The current system is broken," admitted Dr. Peter Levin, VA's Chief Technology Officer, "and it can't be fixed. So, what we are doing is building a new, Web-based (claims processing) system."

The VBA's acting under secretary, Michael Walcoff, took up the tech chief's cudgel and said that the Veterans Benefits Management System now under development will, when combined with a better business process and more people, end the claims crisis. The system will be in place by 2012, he said, and by 2015 no veteran's benefit claim will take more than 125 days to process.

Chairman Filner expressed skepticism, noting that in his 18 years in the House of Representatives, he has heard such promises of revolutionary problem solving time and again. He challenged the VA delegation: "How do I know that, once again, it's not just words?"

Levin then invited Filner to visit the VA's Baltimore Regional Office, where, he explained, a pilot initiative is underway to improve claims processing and service to veterans. Filner accepted the invitation, encouraging representatives of VSOs and other veterans advocates to accompany him.

In the end, the 2010 Claims Summit produced feelings of hope attenuated by caution among attendees that the decades long, and ever-growing challenge of efficiently and efficaciously processing veterans benefits claims will be met by old lessons learned and new technology adopted. As for the House Veterans Affairs Committee, it is far from finished in its scrutiny of the VA claims backlog. On Wednesday the committee will reconvene for a session titled "Examination of VA Regional Office Disability Claims Quality Review Methods - Is VBA's (Veterans Benefits Administration)'s Systematic Technical Accuracy Review (STAR) Making the Grade?"

Legion points to VA's inefficient policies and procedures

Many, if not most 2010 Claims Summit attendees saw new technology as only a partial solution to the claims backlog crisis. Among them was Barry Searle, director of The American Legion's Veterans Affairs and Rehabilitation Division. He pointed to VA policies and procedures, rather than lack of electronic data processing, as a primary cause of the claims logjam.

In testimony prepared for the summit, Searle wrote: "The American Legion approved a resolution recommending (VA claims) adjudicators not receive work credit for a claim until a final decision on that claim has been implemented. It is the position of The American Legion that an emphasis on production numbers increases rather than reduces workload (speed of handling rather than accuracy of decision).

"The American Legion believes that when employees are rewarded or reproved for the number of cases moved, (and) not held accountable for the number of cases properly finalized, an inappropriate work atmosphere can easily develop."

Searle amplified that point. "Symptoms of that atmosphere are ‘top sheeting' and unnecessary generic requests for assistance which delay claims, add to the back log, but do not improve service," he wrote. "Top sheeting is where adjudicators do not take the time to completely review the entire file, but reject or ‘request assistance' - asking for overlooked documentation that is already in the file. This practice moves the file off their desks and a responding credit will be counted. However, when claims are rejected in this fashion, they then go into the appeals process adding to the backlog for invalid reasons."

Searle concluded his written remarks by pointing to difficulties posed by a wasteful by-product of traditional bureaucracy: extensive and redundant paperwork.

"The claims application process is extremely complicated. The 26-page claims form is practically impossible for untrained veterans to complete successfully," he wrote. "Additionally, the all-encompassing concept of the form repeatedly asks the same questions or questions unnecessary to a particular claim. Despite the best efforts of VSOs to convince veterans to allow service officers to assist with their claims, in many cases veterans try to do it alone the first time. They then have their claim rejected and turn to a VSO for an appeal. This again, adds to the backlog unnecessarily."

More in Veterans Benefits Center

 

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sergio.howard

September 3, 2011 - 12:49pm

In my case I did not find the wait to be long but the initial answer was a denied claim. I plan on appealing but the letter stating why it could not be granted doesn't make sense. They sent me a para 38 CFR 3.304(f)(3) about stressors caused by wartime activities, incoming artillery, rocket, mortars or fear of hostile military or terrorist activity as a reasion for denial but "just a little" investigation would make it clear that service in a wartime theater of operations for Division Artillery would qualify. Their own para says "absence of clear and convincing evidence to the contrary and provided the claimed stressor is consistent with the places, types, and circumstances of the veterans service would allow the veterans lay testimony to establish the claimed in-service stressor. They ask for evidence but don't send you their evidence supporting denial. I will seek American Legion assistance.

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September 8, 2010 - 10:45am

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loaded9

March 27, 2010 - 6:59am

AS A VICTIM OF THE REVIEW PROCESS,IM WONDERING WHY APPROVED CLAIMS ARENT REVIEWED WHEN THEY ARE APPROVED. MY CLAIM APPROVED IN JAN 2003 , AND AGAIN APPROVED IN MARCH 2003 TO INCLUDE UNEMPLOYABILITY,AND RULED PERMANENT AND TOTAL, HAS BEEN REVIEWED,AND RULED A MISTAKE AND NOW THE COMPENSATION I WAS GETTING FOR THE LAST 7 YEARS IS NOW DOWN FROM 100% TO 60%, AND SINCE THE REGIONAL OFFICE SAYS THERE WAS AN OVERPAYMENT I KNOW HAVE A DEBT TO THE V.A...WHERES THE JUSTICE FOR A 21 YR VETERAN, CRIPPLED BY BACK AND SHOULDER INJURIES, IF THE VA'S CASE OF IT BEING A MISTAKE IS CORRECT, WHY WASNT IT CORRECTED 7 YRS AGO, BEFORE MY FAMILY AND I STARTED USING THE 100% BENEFITS,( CHAMPVA HEALTH INS, DEPENDENTS EDUCATION, ETC,)HAD SOMEONE DONE THEIR JOB CORRECTLY,I WOULDNT HAVE TO FILE FOR BANKRUPTCY TODAY AND MOVE MY FAMILY INCLUDING MY SPECIAL NEEDS CHILD INTO A HOMELESS SHELTER BECAUSE THE V.A. WISHES TO TAKE WHAT I HAVE BEEN GETTING AND BILL ME FOR AN OVERPAY! OTHER THAN SUICIDE WHAT DO I DO

sfret

March 25, 2010 - 8:49pm

I have undiagnosable nerve conditions after seeing at least half a dozen neurologists and the War Related VA Medical Center in Palo Alto, CA. It is probably gulf war related. I'm afraid to file again. It was such a grueling process the first four years to get 40% for other reasons. I was up to methadone by the time the appeals board met. What a sad statement. A green beret afraid of filing a claim with the VA. I'm in the process of trying to force myself to fill out the paperwork.

pickaxe

March 22, 2010 - 10:49am

My claim has been in the system for over ten years. My Legion VSO did not complete the intial claim form completely or correctly. He told me is was more important to get it in and dated, then the VA would get the rest of the information. 6 remands later I am still waiting. All the remands were for procedual errors on the VA part. But when you read the remand the VA blames me for not doing things correct.During this proccess the leave the vet out of knowing what they are doing,and if you give them the needed info to correct things the VA just ignores you, remands it to tie it up a few more years. And get they get a bonus!

GavinR

November 24, 2010 - 2:59pm

there is always a difference between two points.

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