Doubts remain over VA's ability to end huge disability claims backlog

Thursday - 3/21/2013, 6:31am EDT

Jared Serbu, DoD reporter, Federal News Radio

Download mp3

The Department of Veterans Affairs said it's determined to eliminate its backlog of disability claims by 2015. But at the moment, the problem is getting worse, not better, and congressional overseers say their patience is growing thin.

VA defines the backlog as being made up of any claim that's been pending for 125 days or longer, and the department's statistics show that as of this week, there are nearly 630,000 claims in that category.

VA said the number will be down to zero by 2015, but for now, the numbers are headed in the wrong direction: the current backlog includes 30,000 more cases than it did a year ago.

Veterans currently wait an average 273 days for their claims to be processed. First-time claims coming from veterans who have recently been released from military service take longer — just shy of one year, on average, according to the Iraq and Afghanistan Veterans of America.

Losing patience with VA

Rep. Jeff Miller (R-Fla.), the chairman of the Veterans Affairs Committee, is not pleased.

Rep. Jeff Miller (R-Fla.)

"There are many people, including myself, who are losing patience as we continue to hear the same excuses from VA about increased workload and increased complexity of claims," Miller said at Wednesday's hearing. "However, VA's demonstrated history shows its inability or refusal to forecast problems and anticipate its needs, and the only people paying a price for those failures are the veterans. The time for excuses is over."

VA points out that its decision to open the doors for a new category of Vietnam-era veterans to earn disability payments as a result of presumed exposure to Agent Orange caused a large spike in workload for it claims processors. Combined with the influx of new veterans from the post-9/11 era, demands on the veterans benefits processing system are high.

Nonetheless, the department said it's not making excuses, but rather is implementing a transformation plan in its Veterans Benefits Administration designed to overhaul its processes, technology and training so that it can increase the quantity and quality of the claims it processes.

VBA now is able to handle a record 1 million claims per year and has done so for the past three years in a row, said Allison Hickey, VA's undersecretary for benefits.

Quality over quantity

But members of Congress zeroed in on figures that appeared to show that despite an influx of new claims adjudication personnel, the number of cases VBA handles per full-time equivalent staff member is declining.

"The data I have says that in 1997, we were doing 136 claims per field employee. Today that number is 73," said Rep. Kevin McCarthy (R-Calif.), the majority whip.

Hickey said those numbers may be true on their face, but contended they don't tell the whole story.

"In 1997, I may have been doing more claims per employee, but I was also at 59 percent quality. That's not something anyone on this committee wants me to ever go back to again," she said. "And last year, even doing 1 million claims, we actually increased our quality by almost 4 percentage points."

VA currently processes 86 percent of its disability claims without any errors, Hickey said in her prepared testimony. The 2015 goal for the elimination backlog aims for a 98 percent accuracy rate.

And while the department has promised for years to eliminate the disability backlog, Hickey said its current pledge to pull it off by 2015 is realistic.

"I'm convinced, because I've just seen us do it in our long-term solution for Post-9/11 G.I. Bill claims, where we are now doing 95 percent of our work in less than six days. That tells me that if you put some automation in the system and change the processes, you can achieve some fundamental growth," she said. "In February of last year, when I had 200,000 claims in that inventory, you all were talking to me about that, and you needed to be. Today I have 40,000."

Interagency data sharing

Hickey said VA now is taking major steps it's never taken before to speed up the claims process. As in the area of education claims, she said technology will be a major contributor to changing the trajectory of the backlog. VA is currently in the process of deploying its Veterans Benefits Management System to its field offices throughout the country.

Allison Hickey, undersecretary for benefits, VA

VBMS, which has been deployed to 25 regional offices since last December, will let all new claims be processed electronically, and in combination with VA's eBenefits website, will extend the more efficient paperless process to the legwork that's currently required of individual veterans, Hickey said.

"They can, today, go online and submit a claim in an interface that's a lot like TurboTax. They can upload their own medical evidence, and it goes directly into our paperless IT system. They don't have to get into a car to deliver it, they don't have to go down to one of our centers to find out the status of their claim," she said.

Additionally, VA has begun to speed up the processing of certain claims by creating an "express lane" for disability claims that are relatively uncomplicated and involve only a few medical conditions. The department said that lane shaves about 100 days from the average processing time for a given case and reserves the most complicated cases for VBA's more experienced claims adjudicators.

Hickey said VA has taken other steps to reduce one of the biggest bottlenecks in the claims process: the gathering of medical evidence and other data from other federal agencies.

She said VA has just signed what she termed "game changing" information-sharing agreements with the Internal Revenue Service and the Social Security Administration.

"Many of the claims we have to do require information IRS or SSA have that we've only gotten on an annual basis in the past. I totally appreciate what the leadership at both of those agencies have done, because I'm now going to get that weekly," she said. "That fundamentally changes that piece of the evidence hunt."

DoD delivering complete medical records

And with regard to medical histories, since the vast majority of the records VA needs to adjudicate a disability claim are held by the Defense Department, the Pentagon agreed for the first time to provide VA with a verified, complete package of medical records when a service member is discharged from one of the military services.

"They've stood up cells in the Army and the Air Force. The Navy's going to do it in a slightly different way, but they're not only going out and gathering all of their own medical records, but they're pulling together all the contract medical records from TRICARE. I've never had that before," she said. "They're certifying to me that they have all the service member's medical evidence in that one record so that I'm not doing what I'm doing now, which is exhaustively going out and searching for records that we don't own and never owned in the beginning."

Despite VA's optimism about meeting the 2015 target for eliminating the claims backlog, lawmakers are almost universally skeptical.

Even if technology and process improvements do indeed let the department move claims through the pipeline more quickly, the improvements would have to be sudden and dramatic in order to achieve the 2015 goal, said Rep. Michael Michaud (D-Maine), the committee's ranking member.

"It would require the VA to complete approximately 3.4 million claims in 2 1/2 years. To accomplish this goal, VA would have to start averaging the completion of about 1.36 million claims per year, a 33 percent increase in productivity. In my mind, the math doesn't add up and I'm not sure how we're going to get there by 2015," he said. "I also question whether VA's being up front with Congress about its challenges. In particular, does VBA have enough employees to get the job done? I'm not convinced that it does."

RELATED STORIES:

Lawmakers tell VA 'no more hollow promises' to fix the claims backlog

Beneficiaries claim VA's processing of GI Bill benefits still lackluster

VA testing cash prizes to improve its health record system