[Senate Hearing 110-35]
[From the U.S. Government Publishing Office]
S. Hrg. 110-35
VA CLAIMS ADJUDICATION
AND APPEALS PROCESS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
MARCH 7, 2007
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Larry E. Craig, Idaho, Ranking
Virginia Member
Patty Murray, Washington Arlen Specter, Pennsylvania
Barack Obama, Illinois Richard M. Burr, North Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Lindsey O. Graham, South Carolina
Jim Webb, Virginia Kay Bailey Hutchison, Texas
Jon Tester, Montana John Ensign, Nevada
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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March 7, 2007
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Prepared statement........................................... 2
Craig, Hon. Larry E., Ranking Member, U.S. Senator from Idaho.... 72
Charts:
Fiscal Year 1997 to Fiscal Year 2008 Compensation and
Pension Staffing....................................... 74
Options for Fundamental Reform........................... 76
Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia... 77
Tester, Hon. Jon, U.S. Senator from Montana...................... 78
Webb, Hon. Jim, U.S. Senator from Virginia....................... 79
Obama, Hon. Barack, U.S. Senator from Illinois................... 89
Prepared statement........................................... 91
WITNESSES
Cooper, Hon. Daniel L., Under Secretary for Benefits, Department
of Veterans Affairs; accompanied by Michael Walcoff, Associate
Deputy Under Secretary for Field Operations; and Jack McCoy,
Associate Deputy Under Secretary for Policy and Program
Management..................................................... 3
Prepared statement........................................... 5
Response to written questions submitted by:
Hon. Daniel K. Akaka..................................... 11
Hon. Barack Obama........................................ 50
Hon. Larry E. Craig...................................... 51
Terry, Hon. James P., Chairman, Board of Veterans' Appeals;
accompanied by Ron Garvin, Vice Chairman; and Steve Keller,
Senior Deputy Vice Chairman.................................... 54
Prepared statement........................................... 58
Response to written questions submitted by:
Hon. Daniel K. Akaka..................................... 61
Hon. Barack Obama........................................ 63
Hon. Larry E. Craig...................................... 69
Bertoni, Daniel, Acting Director, Education, Workforce and Income
Security, Government Accountability Office..................... 98
Prepared Statement........................................... 100
Response to written questions submitted by Hon. Barack Obama. 113
Rowan, John, National President, Vietnam Veterans of America..... 113
Surratt, Rick, Deputy National Legislative Director, Disabled
American
Veterans....................................................... 115
Prepared statement........................................... 116
Response to written questions submitted by Hon. Barack Obama. 127
VA CLAIMS ADJUDICATION
AND APPEALS PROCESS
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WEDNESDAY, MARCH 7, 2007
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:31 a.m., in
room SR-418, Russell Senate Office Building, Hon. Daniel K.
Akaka, Chairman of the Committee, presiding.
Present: Senators Akaka, Rockefeller, Obama, Tester, Webb,
and Craig.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. This hearing of the Committee on Veterans'
Affairs will come to order. Aloha and welcome to all of you. I
am pleased that all of you can join us for today's hearing on
the VA adjudication process.
Today's hearing will address a matter that has been an
ongoing concern to this Committee and our Nation's veterans for
many, many years: the timeliness and accuracy of the
adjudication of veterans' disability claims.
In the last Congress, Chairman Craig held two hearings on
the topic. While the Veterans Benefits Administration and the
Board of Veterans' Appeals have made strides in recent years to
make the claims adjudication operation more efficient and
productive, we must admit that much work still needs to be
done.
This year, GAO has once again designated VA's disability
program as a high-risk area and in need of broad reform. Recent
news stories, including most prominently a recent story in
Newsweek magazine, have highlighted some of these shortcomings
and contributed to the public perception that VA is failing to
meet its obligations to our Nation's veterans.
The costs of caring for our veterans must be understood by
Congress and the Administration as nothing short of an ongoing
cost of war. Although the President's Fiscal Year 2008 budget
request is a step in the right direction, it does not provide
enough resources for adjudication personnel. As the veterans
population continues to age and disabled veterans return home
from Iraq and Afghanistan, VBA's workload will continue to
increase in the coming years.
The time it takes to process a disability claim continues
to be a matter of concern. While progress has been made in
recent years, VBA remains nearly 2 months short of reaching its
strategic goal of 125 days to process a claim. The majority
Members of the Committee recommended an additional $40 million
for VBA field offices and an additional $3.7 million for VBA
above the President's budget request to hire new staff. We also
endorsed increased funding for VA's training initiatives.
I am interested in hearing from Admiral Cooper about VBA's
new policy of prioritizing claims from veterans of the Global
War on Terror. I, again, thank you for being here today. I look
forward to this hearing.
[The prepared statement of Senator Akaka follows:]
Prepared Statement of Hon. Daniel K. Akaka, Chairman,
U.S. Senator from Hawaii
Aloha and welcome to all. I am pleased that you can join us for
today's oversight hearing on the VA adjudication process. I look
forward to having a constructive conversation with Admiral Cooper,
Chairman Terry and our other witnesses.
Today's hearing will address a matter that has been an ongoing
concern to this Committee and our Nation's veterans for many years--the
timeliness and accuracy of the adjudication of veterans' disability
claims. In the last Congress, Chairman Craig held two hearings on the
topic.
While the Veterans Benefits Administration and the Board of
Veterans' Appeal have made strides in recent years to make the claims
adjudication operation more efficient and productive, much work still
needs to be done. This year GAO has once again designated VA's
disability program as a ``high risk area'' in need of broad reform.
Recent news stories, including, most prominently, a recent cover
story in Newsweek magazine, have highlighted some of these shortcomings
and contributed to the public perception that VA is failing to meet its
obligations to our Nation's veterans. I am confident that the VA is
fully committed to its mission, but there are areas where improvements
must be made in order to better serve our veterans and restore the
Nation's faith in the institutions charged with caring for them.
The cost of caring for our veterans must be understood by Congress
and the Administration as nothing short of an ongoing cost of war.
Although the President's Fiscal Year 2008 Budget Request is a step in
the right direction, it does not provide enough resources for
adjudication personnel. We must ensure that sufficient funding is
available to provide veterans with timely and accurate responses to
their claims. As the veterans' population continues to age and disabled
veterans return home from Iraq and Afghanistan, VBA's workload will
continue to increase in the coming years. Nevertheless, VA predicts
that the number of new receipts will essentially flatline in Fiscal
Years 2007 and 2008. I am concerned that this projection may
underestimate VBA's workload. The most recent numbers indicate that
through the first quarter of Fiscal Year 2007, VA has received 8
percent more claims than expected. Without prompt action, we will fail
to keep our promise to provide timely and accurate decisions to
veterans.
The time necessary to process a disability claim continues to be a
matter of concern. While progress has been made in recent years, VBA
remains nearly 2 months short of reaching its strategic goal of 125
days to process a claim. VA must find innovative ways to absorb the
burdens of new legislation and court decisions, as well as the
increasing complexity of claims filed.
The Democratic and Independent Members of the Committee recommended
an additional $40 million for VBA field offices and an additional $3.7
million for BVA above the President's budget request to hire new staff.
We also endorsed increased funding for VA's training initiatives. It
takes approximately two years before a new hire fully contributes to
the bottom line. Thus, proper funding and infrastructure for training
must be in place before VBA finds itself dealing with an unexpected
increase in its workload volume. We hope that these increases for
staffing and training will be included in the Budget Resolution.
I am interested in hearing from Admiral Cooper and Mr. Terry on
their plans to tackle both immediate and future challenges. I am
particularly interested in hearing from Admiral Cooper about VBA's new
policy of prioritizing claims from veterans of the Global War on
Terror. How will this plan be implemented, and what impact it will have
on claims process management at the regional office level? I am
encouraged to hear that VA is committed to serving our veterans who
have just returned from the battlefield, but we must also ensure that
this policy does not adversely affect veterans of prior wars.
I again thank you for being here today. I look forward to our
witnesses' testimony.
Chairman Akaka. This is going to be a busy morning. Members
are in other Committees at this moment, and they will be coming
in as they come from other Committees. There will be votes as
well. However, we will continue with the hearing. At this time
I would like to call on Admiral Cooper for your testimony.
STATEMENT OF HON. DANIEL L. COOPER, UNDER SECRETARY FOR
BENEFITS, DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY MICHAEL WALCOFF, ASSOCIATE DEPUTY UNDER
SECRETARY FOR FIELD OPERATIONS; AND JACK McCOY, ASSOCIATE
DEPUTY UNDER SECRETARY FOR
POLICY AND PROGRAM MANAGEMENT
Mr. Cooper. Thank you, sir.
Mr. Chairman, Members of the Committee, it is my pleasure
to be here today to discuss the Disability Compensation
Program. I am pleased to be accompanied by Mr. Michael Walcoff,
who is VBA's Associate Deputy Under Secretary for Field
Operations, and Mr. Jack McCoy, the Associate Deputy for Policy
and Program Management. And I will allow Judge Terry to
introduce his particular people.
The Veterans Benefits Administration is responsible for
administering a wide range of benefits and services for
veterans, their families, and their survivors. The heart of our
mission is the Disability Compensation Program.
In 2006, we produced over 774,000 disability
determinations. We also performed more than 2 million decision
actions of all types to address new claims and to maintain
those already on the rolls. Additionally, we handled over 6.6
million phone calls, conducted over a million interviews,
briefed more than 390,000 service personnel, and conducted
65,000 hours of outreach to military members, former prisoners
of war, homeless, minorities, women, and other targeted groups.
Today I will try to discuss the challenges we face in
providing timely, accurate, and consistent determinations for
veterans' claims for disability compensation. I will also
discuss some of the actions we are taking.
The number of veterans filing initial disability
compensation claims and claims for additional benefits has
increased every year since 2000. Disability claims from
veterans of all eras increased from 578,700 in 2000 to 806,300
in 2006. Comparing those 2 years, 2000 and 2006, this
represents an increase of 228,000 claims a year, or 38 percent.
Among the most important factors leading to the sustained
high levels of claims activity are: Operations OIF and OEF, the
present War on Terror; our increased and extensive outreach
that we do; and the additional beneficiaries on the rolls who
come in for additional claims and adjustments to their claims.
The absolute increase in claims is not the only change
affecting the claims processing environment. As stated in the
recent GAO report, the great number of disabilities that the
average veteran now identifies, the increasing complexity of
the disabilities that we see, and the changes in law and
processes are additional challenges to the claims processing
workload. The trend toward increasingly complex and difficult-
to-rate claims is expected to continue for the foreseeable
future.
A significant portion of our workload comes from appeals of
regional office decisions, remands from the board and from the
court. A large portion of the work that we do, however, is in
account maintenance activities for such things as dependency
adjustments, death pension awards, income adjustments. As the
overall claims increase, so do appellate and non-rating-related
workloads.
To ensure accurate benefit decisions given the increases in
both volume and complexity of the workload, we have established
an aggressive and comprehensive program of quality assurance
and oversight to assess compliance with VBA claims processing
policy and procedures and to assure consistent application. Our
quality over these last 5 years has improved approximately 8 to
9 percent.
It is critical that our employees receive the essential
guidance, materials, and tools to meet the ever-changing and
increasingly complex workload. The frequent changes in the
benefits programs require that we have good, stable training.
To that end, VBA has deployed new training tools and
centralized training programs. We have standardized computer-
based tools that we use for which each of our people has
access. And, in addition, we have a mandatory cycle of training
for all Veterans Service Center employees that has been
developed consisting of 80 hours a year for their training.
To balance the inventory of disability claims across
regional offices, we execute a ``brokering'' strategy in which
rating claims are sent from those stations with high
inventories to other stations with available capacity to
process additional rating work. Brokering allows the
organization to address simultaneously the local and the
national inventory by maximizing the use of those available
resources.
The consolidation of specialized processing operations to
provide better and more consistent decisions is one of the acts
that we have taken. Some of our consolidation efforts include
establishment of the Pension Maintenance Centers at three
sites; the Tiger Team that we have in Cleveland for veterans
who are over 70 years old with claims pending of over a year;
the Appeals Management center here in Washington, which takes
the remands from the court. We have the Benefits Delivery at
Discharge Program which has got into full functioning this
year, and we have centralized all radiation claims in one
specific regional office.
We are aggressively pursuing measures to decrease the
pending inventory of disability claims and to shorten the time
the veterans must wait, but our pending inventory right now is
about 400,000 claims, and the average processing time--that is,
time to complete--is about 175 days.
We are increasing staffing levels to reduce the pending
inventory and to provide the level of service expected by the
American people and our veterans. We began aggressively hiring
additional staff in Fiscal Year 2006. We have increased the
onboard strength between January of 2006 and January of 2007 by
580 employees. With a workforce that is sufficiently large,
correctly balanced, and properly trained, VBA can successfully
meet the needs of our veterans.
We will continue to accelerate hiring and fund additional
training necessary for this new staff this fiscal year.
Since the onset of the combat operations in Iraq and
Afghanistan, VBA has worked hard to expedite and case-manage
services for those seriously injured Operations Iraqi and
Enduring Freedom veterans and their families. This
individualized service begins at the military medical
facilities where the injured servicemembers return for
treatment and continues as these servicemembers are medically
separated and enter the VA medical care and benefits systems.
We assign special benefits counselors, social workers, and case
managers to work with these veterans and their families
throughout the transition and to help ensure expedited delivery
of benefits.
Last month, the Secretary directed that we start a new
initiative to provide priority processing of all OIF/OEF
veterans' disability claims. This will allow all of these brave
men and women returning from the OIF/OEF theaters who were not
seriously injured but who, nevertheless, have a disability
incurred or aggravated during their military service to enter
the VA system and begin receiving disability benefits as soon
as possible after separation.
Last month, we began processing all disability compensation
and pension claims received from OIF/OEF veterans on a priority
basis.
Through these initiatives, VBA will address the challenges
facing our organization and continue to improve claims
processing. We will continue to assess our policies, processes,
and approaches to take advantage of any improvement
opportunities we can identify and to ensure that we are
achieving the desired performance outcomes. It is vital that we
improve production, but we must ensure that we maintain and
continue to improve quality and consistency.
Mr. Chairman, that concludes my testimony. I greatly
appreciate the chance to be here before you today.
[The prepared statement of Mr. Cooper follows:]
Prepared Statement of Hon. Daniel L. Cooper, Under Secretary
for Benefits, Department of Veterans Affairs
Mr. Chairman and Members of the Committee, it is my pleasure to be
here today to discuss the Disability Compensation Program. I am pleased
to be accompanied by Mr. Michael Walcoff, VBA's Associate Deputy Under
Secretary for Field Operations, and Mr. Jack McCoy, VBA's Associate
Deputy Under Secretary for Policy and Program Management.
The Veterans Benefits Administration (VBA) is responsible for
administering a wide range of benefits and services for veterans, their
families, and their survivors. We manage a life insurance program that
consistently ranks among the best in the Nation. We promote home
ownership through the loan guaranty program and help veterans and their
dependents seek greater education and economic opportunities through
the highly successful Montgomery GI Bill program and other educational
programs. For qualifying veterans with disabilities, our Vocational
Rehabilitation and Employment Program provides both rehabilitation and
training and assists them in reentering the civilian workforce. We are
proud of our achievements in all these vital areas.
The heart of our mission is the Disability Compensation Program. In
Fiscal Year 2006, we produced over 774,000 disability determinations.
We also performed more than two million decision actions of all types
to address new claims and to maintain those already on the rolls.
Additionally, we handled over 6.6 million phone calls; conducted over a
million interviews; briefed more than 390,000 service persons; and
conducted nearly 65,000 hours of outreach to military members, former
prisoners of war, homeless, minorities, women, and other targeted
groups.
Today, I will discuss the challenges we face in providing timely,
accurate, and consistent determinations on veterans' claims for
disability compensation. These challenges include the growth of the
disability claims workload, the increasingly complex nature of that
workload, the rise in appellate processing, and the absolute need to
produce accurate benefit decisions. I will also discuss some of the
actions we are taking to improve claims processing. We view these
efforts as opportunities to achieve greater processing efficiencies
and, thus, to enhance service to veterans.
growth of disability claims workload
The number of veterans filing initial disability compensation
claims and claims for increased benefits has increased every year since
Fiscal Year 2000. Disability claims from returning Afghanistan and Iraq
war veterans as well as from veterans of earlier periods of war
increased from 578,773 in Fiscal Year 2000 to 806,382 in Fiscal Year
2006. For Fiscal Year 2006 alone, this represents an increase of nearly
228,000 claims or 38 percent over the 2000 base year. It is expected
that this high level of claims activity will continue over the next 5
years.
The primary factors leading to the sustained high levels of claims
activity are: Operation Iraqi Freedom (OIF) and Operation Enduring
Freedom (OEF); more beneficiaries on the rolls, with resulting
additional claims for increased benefits; improved and expanded
outreach to active-duty servicemembers, Guard and Reserve personnel,
survivors, and veterans of earlier conflicts; and implementation of
Combat Related Special Compensation (CRSC) and Concurrent Disability
and Retired Pay (CDRP) programs by the Department of Defense (DOD).
Ongoing hostilities in Afghanistan and Iraq are expected to
continue to increase the VA compensation workload. Earlier studies by
VA indicate that the most significant indicator of new claims activity
is the size of the active force. Over 1.45 million active-duty
servicemembers, members of the National Guard, and reservists have thus
far been deployed in the Global War on Terrorism. Over 685,000 have
returned and been discharged.
Whether deployed to foreign-duty stations or maintaining security
in the United States, the authorized size of the active force as well
as the mobilization of thousands of citizen soldiers means that the
size of the force on active duty has significantly increased. The
claims rate for veterans of the Gulf War Era, which began in 1991 and
includes veterans who are currently serving in Operations Enduring
Freedom and Iraqi Freedom, is significant. Veterans and survivors of
the Gulf War Era currently comprise the second largest population of
veterans receiving benefits after Vietnam Era veterans.
The number of veterans receiving compensation has increased by
almost 400,000 since 2000--from just over 2.3 million veterans to
nearly 2.7 million in 2006. This increased number of compensation
recipients, many of whom suffer from chronic progressive disabilities
such as diabetes, mental illness, and cardiovascular disabilities, will
continue to stimulate more claims for increased benefits in the coming
years as these veterans age and their conditions worsen. Reopened
disability compensation claims currently comprise 54 percent of VBA's
disability claims receipts.
Additionally, an increase in claimants and beneficiaries on the
rolls has a direct relationship to the workload in the public contact
area of telephone interviews, personal interviews, and correspondence,
including electronic correspondence. Veterans Service Center employees
in the regional offices last year conducted over six million telephone
interviews and one million personal interviews.
VA is committed to increased outreach efforts to active-duty
personnel. These outreach efforts result in significantly higher claims
rates. Original claim receipts increased from 111,672 in Fiscal Year
2000 to 217,343 in Fiscal Year 2006--a 95 percent increase. We believe
this increase is directly related to our aggressive outreach programs;
we believe this increasing trend will continue.
Separating military personnel can receive enhanced services through
our Benefits Delivery at Discharge (BDD) Program. On either a permanent
or itinerant basis, VBA staff members are stationed at 140 military
discharge points around the Nation, as well as in Korea and Germany.
Additionally, VBA employees conduct transition assistance briefings in
Germany, Italy, Korea, England, Japan, Okinawa, and Spain, and
occasionally aboard ship as servicemembers return to the United States.
Combat-Related Special Compensation (CRSC), a benefit available
from DOD for certain military retirees with specific qualifying combat-
related disabilities defined by statute, became effective July 1, 2003,
and was later expanded effective January 1, 2004. Today, more than
54,000 military retirees receive this benefit. This benefit and
Concurrent Retired and Disability Pay (CRDP), another DOD program that
permits partial to total restoration of retired pay previously waived
to receive VA compensation, further contribute to increased claims
activity for VBA.
It is now potentially advantageous for the majority of our military
retirees, even those with relatively minor disabilities, to file claims
with VA and to receive VA disability compensation, since their waived
retired pay may be restored and not be subject to waiver in the future.
Approximately 194,000 retirees receive CRDP. The number of military
retirees receiving VA compensation has increased since the advent of
these programs to over 840,000. There is also now significant incentive
for retirees receiving compensation to file claims for increased VA
benefits, as the increased amounts may also no longer be subject to
offset. The total number of retirees as of the end of Fiscal Year 2006
was approximately two million, meaning that over 40 percent of all U.S.
military retirees now receive VA benefits.
complexity of claims processing workload
The increase in claims receipts is not the only change affecting
the claims processing environment. The greater number of disabilities
veterans now claim, the increasing complexity of the disabilities being
claimed, and the changes in law and processes pose additional
challenges to the claims processing workload. The trend toward
increasingly complex and difficult-to-rate claims is expected to
continue for the foreseeable future.
A claim becomes more complex as the number of directly claimed
conditions (issues) increases because of the larger number of variables
that must be considered and addressed. Multiple regulations, multiple
sources of evidence, and multiple potential effective dates and
presumptive periods must be considered. The effect of these factors
increases proportionately and sometimes exponentially as the number of
claimed conditions increases. Additionally, as the number of claimed
conditions increases, the potential for additional unclaimed but
secondary, aggravated, and inferred issues increases as well, further
complicating the preparation of adequate and comprehensive Veterans
Claims Assistance Act of 2000 (VCAA) notice and rating decisions. Since
veterans are able to appeal decisions on specific disabilities to the
Board of Veterans' Appeals (Board) and the United States Court of
Appeals for Veterans Claims (CAVC), the increasing number of claimed
conditions significantly increases the potential for appeal.
VA's experience since 2000 demonstrates that the trend of
increasing numbers of conditions claimed is system-wide, not just at
special intake locations such as BDD sites. The number of cases with
eight or more disabilities claimed increased from 21,814 in Fiscal Year
2000 to 51,260 in Fiscal Year 2006, representing a 135 percent increase
over the 2000 base year and a 15 percent increase over Fiscal Year
2005.
Combat and deployment of U.S. Forces to underdeveloped regions of
the world have resulted in new and complex disability claims based on
environmental and infectious risks, traumatic brain injuries, complex
combat injuries involving multiple body systems, concerns about
vaccinations, and other variabilities.
In addition, the aging of the veteran population that is service
connected for diabetes adds to the complexity of claimed disabilities.
Approximately 253,000 veterans are service connected for diabetes, with
more than 220,000 of these awards based upon the presumption of
herbicide exposure in Vietnam. As veterans with diabetes reach and move
past the 10-year point since the initial diagnosis, additional
secondary conditions tend to become manifest. VA has already begun
seeing increasingly complex medical cases involving neuropathies,
vision problems, cardiovascular problems, and other issues directly
related to diabetes. If secondary conditions are not specifically
claimed by a veteran, the rating specialist must be alert to identify
them. This increasing complexity of the disabilities adds to the
increased difficulty of our workload and the resources needed to
adequately process it.
The number of veterans submitting claims for post-traumatic stress
disorder (PTSD) has grown dramatically and contributed to increased
complexity in claims processing. From Fiscal Year 2000 through Fiscal
Year 2006, the number of veterans receiving compensation for PTSD has
increased from more than 130,000 to nearly 270,000. These cases present
unique processing requirements to obtain the evidence needed to
substantiate the event causing the stress disorder.
The Veterans Claims Assistance Act (VCAA) has significantly
increased both the length of time and the specific requirements of
claims development. VA's notification and development duties increased
as a result of VCAA, adding more steps to the claims process and
lengthening the time it takes to develop and decide a claim. Since
enactment, we are required to review the claims at additional points in
the decision process. Mistakes due to failure to address all issues or
an incomplete understanding of the claim when initially developed have
resulted in significant rework and remands from the Board of Veterans'
Appeals and the United States Court of Appeals for Veterans Claims.
VCAA requires VA to provide written notice to claimants of the
evidence required to substantiate a claim and of which party (VA or the
claimant) is responsible for acquiring that evidence. Under VCAA, VA's
``duty to assist'' the claimant in perfecting and successfully
prosecuting his or her claim extends to obtaining government records,
assisting with getting private records, and obtaining all necessary
medical examinations and medical opinions. As a claim progresses,
additional notifications to the veteran may be required.
appellate and non-rating workload
A significant portion of VBA's workload comes from appeals of
regional office decisions, remands by the Board and the CAVC, and
account maintenance activities for beneficiaries already receiving
benefits. As overall claim receipts increase, so do appellate and non-
rating related workloads.
As VBA renders more disability decisions, a natural outcome of that
process is more appeals filed by veterans and survivors who disagree
with some part of the decision made in their case. Veterans can appeal
decisions denying service connection for any conditions claimed. They
may also appeal the effective date of an award and the evaluation
assigned to a disability.
Appeals of regional office decisions and remands by the Board and
the CAVC following appeal are some of the most challenging types of
cases to process because of their complexity and the growing body of
evidence necessary to process these claims. In recent years, the appeal
rate on disability determinations has climbed from an historical rate
prior to 2000 of approximately 7 percent of all disability decisions to
the current rate of 11 percent. There are more than 130,000 appeals now
pending in the regional offices and the Appeals Management Center. This
number includes cases requiring processing prior to transfer of the
appeal to the Board and cases remanded by the Board and the CAVC
following an appeal. There are over 30,000 additional appeals pending
at the Board of Veterans' Appeals.
In 2006, VA completed over two million award actions of all types.
Of that number, more than 774,000 were award actions in connection with
disability rating decisions, and the remaining were associated with
account maintenance (dependency adjustments, death pension awards,
income adjustments, etc.). The number of veterans on our rolls has
increased by nearly 400,000 in recent years, and the total number of
veterans and survivors on our rolls is now over 3.6 million. The
combination of the higher number of beneficiaries presently on our
rolls and the sustained and projected high levels of new claims
activity will result in continued growth in account maintenance
activities.
claims processing improvement (cpi) model
A product of the VA Claims Processing Task Force, established by
former Secretary of Veterans Affairs Anthony J. Principi, was the
implementation of the Claims Processing Improvement (CPI) model. The
CPI implementation established consistent organizational structure and
work processes across all regional offices. Work processes were
reengineered and specialized teams established to reduce the number of
tasks performed by individual decisionmakers, establish consistency in
work flow and process, and incorporate a triage approach to incoming
claims.
We continually review the CPI model based upon feedback from
regional offices, the needs of the organization, and the timeliness and
quality improvements we seek. The changing workload and workforce have
necessitated a review of the model to ensure the most effective method
of organizing work and resources to maximize performance. The CPI Model
Task Force was assembled in January 2006 to reevaluate the CPI model to
assess its overall effectiveness and improve consistency and efficiency
in claims processing. The CPI Task Force solicited recommendations and
rationale for changes to the CPI model from all regional office
leadership. Interviews with field station management, reviews of recent
site-visit reports and CPI deviation requests, and analyses of other
pertinent documents were conducted. The final recommendations of the
Task Force are currently being studied in pilot programs at select
regional offices.
claims processing accuracy
To ensure accurate benefit decisions, given the increases in volume
and complexity of the workload, we have established an aggressive and
comprehensive program of quality assurance and oversight to assess
compliance with VBA claims processing policy and procedures and assure
consistent application.
The Systematic Technical Accuracy Review (STAR) program includes
review of work in three areas: rating accuracy, authorization accuracy,
and fiduciary program accuracy. Overall station accuracy averages for
these three areas are included in the regional office director's
performance standard and the station's performance measures. STAR
results are readily available to facilitate analysis and to allow for
the delivery of targeted training at the regional office level. C&P
Service conducts satellite broadcast training sessions based on an
analysis of national STAR error trends.
In addition to the STAR program, C&P Service identifies unusual
patterns of variance in claims adjudication by diagnostic code, and
then reviews selected disabilities to assess the level of decision
consistency among and between regional offices. These studies are used
to identify where additional guidance and training are needed to
improve consistency and accuracy, as well as to drive procedural or
regulatory changes. Over the last 4 years, our quality has risen
significantly from 81 percent to 89 percent.
Site surveys of regional offices address compliance with
procedures, both from a management perspective in the operation of the
service center and from a program administration perspective, with
particular emphasis on current consistency issues. Training is
provided, when appropriate, to address gaps identified as part of the
site survey.
training
It is critical that our employees receive the essential guidance,
materials, and tools to meet the ever-changing and increasingly complex
demands of their decisionmaking responsibilities. To that end VBA has
deployed new training tools and centralized training programs that
support accurate and consistent decisionmaking.
New hires receive comprehensive training and a consistent
foundation in claims processing principles through a national
centralized training program called ``Challenge.'' After the initial
centralized training, employees follow a national standardized training
curriculum (full lesson plans, handouts, student guides, instructor
guides, and slides for classroom instruction) available to all regional
offices. Standardized computer-based tools have been developed for
training decisionmakers (69 modules completed and an additional 8 in
development). Training letters and satellite broadcasts on the proper
approach to rating complex issues are provided to the field stations.
In addition, a mandatory cycle of training for all Veterans Service
Center employees has been developed consisting of an 80-hour annual
curriculum.
distribution of rating workload
To balance the inventory of disability claims across regional
offices, VBA implemented a ``brokering'' strategy in which rating cases
are sent from stations with high inventories to other stations with the
capacity to process additional rating work. Brokering allows the
organization to address simultaneously the local and national inventory
by maximizing use of available resources.
Brokering plans are developed on a monthly basis. Stations are
selected for brokering based on the percentage gap between their
current inventory of pending claims and their established end-of-year
inventory target. Stations with the greatest percentage gap are asked
to send ready-to-rate cases to other stations for rating decisions. The
stations participating in brokering changes over time as stations are
able to bring the pending inventory in line with established targets.
consolidation of specialized operations
The consolidation of specialized processing operations for certain
types of claims has been implemented to provide better and more
consistent decisions. Three Pension Maintenance Centers were
established to consolidate the complex and labor-intensive work
involved in ensuring the continued eligibility and appropriateness of
benefit amounts for pension recipients. We are exploring the
centralization of all pension adjudications in these Centers.
In November 2001, a Tiger Team was established at the Cleveland
Regional Office to adjudicate the claims of veterans age 70 and older.
VBA has also established an Appeals Management Center to consolidate
expertise in processing remands from the Board of Veterans' Appeals. In
a similar manner, a centralized Casualty Assistance Unit was
established to process all in-service death claims. VBA has also
centralized the processing of all pending radiation claims to the
Jackson RO. The BDD program provides servicemembers with briefings on
VA benefits, assistance with completing forms, and a disability
examination before leaving service. The goal of this program is to
deliver benefits within 60 days following discharge. VBA has
consolidated the rating aspects of our BDD initiatives, which will
bring greater consistency of decisions on claims filed by newly
separated veterans. We also established two Development Centers in
Phoenix and Roanoke to assist regional offices in obtaining the
required evidence and preparing cases for decision.
We are looking for ways to achieve additional organizational
efficiencies through consolidation of other aspects of our claims
processing, including death benefits, fiduciary activities, and
telephone service.
inventory reduction
VBA is aggressively pursuing measures to decrease the pending
inventory of disability claims and shorten the time veterans must wait
for decisions on their claims.
Our pending inventory of rating related claims is currently about
400,000 claims, and average processing time is 175 days. However, all
400,000 claims in our inventory should not be considered as
``backlog''; this number includes all claims, whether pending only a
few days or a number of months. Under the very best of circumstances,
it takes about 4 months to fully develop a claim (obtain military and
private medical records, schedule necessary medical examinations and
receive results, evaluate evidence, etc.). Based on our projected
receipts of 800,000 claims and our timeliness performance target of 145
days, our expected level of pending inventory with no backlog would be
approximately 318,000 claims.
We are increasing staffing levels to reduce the pending inventory
and provide the level of service expected by the American people. We
began aggressively hiring additional staff in Fiscal Year 2006,
increasing our on-board strength by over 580 employees between January
2006 and January 2007. With a workforce that is sufficiently large and
correctly balanced, VBA can successfully meet the needs of our
veterans.
Our plan is to continue to accelerate hiring and fund additional
training programs for new staff this fiscal year. However, because it
requires an average of 2 or 3 years for our decisionmakers to become
fully productive, increased staffing levels do not produce immediate
production improvements. Performance improvements from increased
staffing are more evident in the second and third years. We have
therefore also increased overtime funding this year and recruited
retired claims processors to return to work as reemployed annuitants in
order to increase decision output.
priority processing for oif/oef veterans
Since the onset of the combat operations in Iraq and Afghanistan,
VA has provided expedited and case-managed services for all seriously
injured Operations Iraqi and Enduring Freedom (OIF/OEF) veterans and
their families. This individualized service begins at the military
medical facilities where the injured servicemembers return for
treatment, and continues as these servicemembers are medically
separated and enter the VA medical care and benefits systems. VA
assigns special benefits counselors, social workers, and case-managers
to work with these servicemembers and their families throughout the
transition to VA care and benefits systems, and to ensure expedited
delivery of all benefits.
The Secretary of Veterans Affairs recently announced a new
initiative to provide priority processing of all OIF/OEF veterans'
disability claims. This will allow all the brave men and women
returning from the OIF/OEF theaters who were not seriously injured in
combat, but who nevertheless have a disability incurred or aggravated
during their military service, to enter the VA system and begin
receiving disability benefits as soon as possible after separation.
Last month, we began processing disability compensation and pension
claims received from OIF/OEF veterans on a priority basis. This
initiative covers all active duty, National Guard, and Reserve veterans
who were deployed in the OIF/OEF theaters or in support of these combat
operations, as identified by the Department of Defense (DOD).
We have designated our two Development Centers in Roanoke and
Phoenix and three of our Resource Centers as a special ``Tiger Team''
for processing OIF/OEF claims. The two Development Centers will obtain
the evidence needed to properly develop the OIF/OEF claims. The three
Resource Centers, located in Muskogee, San Diego, and Huntington, will
rate OIF/OEF claims for regional offices with the heaviest workloads.
Medical examinations needed to support OIF/OEF veterans' claims are
also being expedited.
We are expanding our outreach programs for National Guard and
Reserve components and its participation in OIF/OEF community events
and other information dissemination activities. An OIF/OEF Team is
being established at VBA Headquarters to address all OIF/OEF
operational and outreach issues at the national level and to support
and assist newly designated OIF/OEF Managers at each regional office.
The VBA OIF/OEF Team will also direct and coordinate national Memoranda
of Understanding (MOU) with each of the Reserve Components to formalize
relationships with them, mirroring the agreement between VA and the
National Guard Bureau signed in 2005. Having an MOU with each Reserve
Component will ensure that VA is provided service medical records and
notified of ``when and where'' Reserve members are available to be
briefed during the demobilization process and at later times.
In order to ensure that VA benefits information is provided to all
separating Guard and Reserve servicemembers, we will work with DOD to
discuss the possibility of expanding VA's role in DOD's military pre-
separation process. Specifically, we will assess the feasibility of
providing a new ``Claims Workshop'' in conjunction with VA benefits
briefings. At such workshops, groups of servicemembers would be
instructed on how to complete the general portions of the VA
application forms. Following the general instruction segment, personal
interviews would be conducted with those applying for individual VA
benefits.
Mr. Chairman, this concludes my testimony. I greatly appreciate
being here today and look forward to answering your questions.
______
Response to Written Question Submitted by Hon. Daniel K. Akaka to
Hon. Daniel L. Cooper, Under Secretary for Benefits, Department of
Veterans Affairs
Question 1. It seems clear that the Department of Defense is
keeping injured servicemembers on active duty longer than they have in
the past. What, if any, impact does this have on VA's effort to provide
timely and accurate adjudication of disability claims?
Response. The Department of Veterans Affairs (VA) disability
compensation may not be paid to servicemembers while on active duty,
therefore the length of time on active duty does not directly affect
timeliness of claims processing. Since the onset of combat operations
in Afghanistan and Iraq, we have provided case-managed services to all
seriously injured servicemembers returning from combat zones, and we
have made the processing of their claims our highest priority. We have
assigned benefits counselors to the 10 major military treatment
facilities (MTF), including Walter Reed Army Medical Center. The
counselors work with the injured servicemembers, the military, the
Veterans Health Administration, and family members to explain benefits,
assist in completing claims, and gather supporting medical records and
other evidence for the servicemembers' claims for disability
compensation so that VA disability benefits can be awarded immediately
following separation from service.
The involvement of benefits counselors early in the transition also
allows VA to provide some benefits, such as the Traumatic
Servicemembers' Group Life Insurance (TSGLI), automobile and adaptive
equipment, and specially adapted housing benefits, to eligible
servicemembers while still on active duty.
As servicemembers are transferred from MTFs to other Department of
Defense (DOD) facilities or VA care, the benefits counselors notify the
appropriate regional office of the transfer. All regional offices have
established points of contact with the MTFs and VA medical centers in
their jurisdiction to ensure prompt notification of arrival, transfer,
and discharge of seriously injured servicemembers. All regional offices
have also designated Operation Enduring Freedom/Operation Iraqi Freedom
(OEF/OIF) case managers, who maintain regular contact with injured
servicemembers and veterans to ensure their needs are being met.
Each claim from a seriously injured OEF/OIF veteran is case-managed
to ensure expeditious processing. The regional office directors call
these seriously injured veterans to welcome them home and advise them
that the OEF/OIF case manager will assist them through the claims
process.
Question 2. Please provide to me any written guidance that has been
given to the field regarding the priority processing of claims from
veterans of the Global War on Terror.
Response. All VA regional offices have been provided written
guidance regarding the requirements to expedite processing of all OEF/
OIF claims. Copies of two Veterans Benefits Administration (VBA)
letters providing instructions to the regional offices, dated March 8,
2005 and January 30, 2007, are attached.
[Copies of the Veterans Benefits Administration letters providing
instructions to the regional offices follow:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
In addition to the written guidance, the OEF/OIF priority claims
processing initiative has been extensively discussed with regional
office directors and managers on several nationwide conference calls.
Our four area directors have also conducted conferences with the
regional offices in their jurisdictions covering the procedures and
expectations for expedited OEF/OIF claims processing. In mid-March, VBA
hosted a conference attended by the regional office OEF/OIF
coordinators. This conference provided additional guidance regarding
services for seriously injured servicemembers and veterans, as well as
refresher training on case management principles.
Question 3. At what point in the process of DOD's consideration of
whether an injured servicemember is going to remain on active duty or
be processed for separation from the military does VA help
servicemembers fill out and submit claims for VA compensation? How are
these claims tracked once they are submitted?
Response. Our benefits counselors who are working with the
seriously injured OEF/OIF servicemembers at the MTFs indicate that the
start of the Military Evaluation Board (MEB) process is usually also
the best time to begin the VA disability compensation claim process. It
is at this point that the medical evidence is usually compiled and
available. Completion of the MEB/Physical Evaluation Board (PEB)
process and separation from service is usually about 6 months from this
point. For the very seriously injured OEF/OIF servicemember, the VA
claims process can often begin earlier in connection with claims for
benefits payable while on active duty, such as the automobile and
adaptive equipment grant.
Servicemembers who are in ``medical hold'' are also provided
opportunities to participate in our Transition Assistance Program (TAP)
and Disabled Transition Assistance Program (DTAP) briefings, where
benefits counselors are available to assist in preparing and submitting
claims for benefits. For those who are not seriously injured, it is
appropriate to begin the VA disability claims process at the time of
referral to the PEB (following the MEB ``fitness for duty'' decision).
Controls are established in our Benefits Delivery Network
processing system to track and monitor claims from seriously injured
OEF/OIF veterans. Each claim from a seriously injured OEF/OIF veterans
also case-managed to ensure expeditious processing.
We are very excited about a new application that will provide VA
with the ability to track servicemembers from the battlefield through
Landstuhl, Germany, the MTFs, and on to the VA medical facility. The
new application, known as the Veterans Tracking Application (VTA), is a
modified version of DOD's Joint Patient Tracking Application--a Web-
based patient tracking and management tool that collects, manages, and
reports on patients arriving at MTFs from forward deployed locations.
The VTA Web-based system allows approved VA users to access this
real-time information about the servicemembers we serve and track
injured active duty servicemembers while they transition to veteran
status. VTA will have all medically evaluated OEF/OIF servicemembers in
the database as necessary to provide VA care and benefit claims
support. This application was developed for VA to coordinate care from
an MTF to a VA medical center to ensure that VA will know where the
servicemember is currently located, where the patient came from, and
who has seen the patient. The application is also designed to identify
where servicemembers filed claims and which VBA counselor assisted the
servicemember in the claims process. The application has an historic
record feature to ensure we preserve all status changes. Full
implementation was completed at the end of April.
Question 4. What is the status of VBA's efforts to move toward
electronic claims files?
Response. This question concerning ``electronic claims files''
appears to relate to our efforts to expand our use of electronic data
and records in place of paper records. We are working to integrate
``paperless'' processing into our data and information systems and
processing procedures. We are using imaging technology to support
paperless processing in all of our education and insurance benefits
programs. We are also incorporating imaging technology and electronic
records in our pension program processing.
We are now conducting a pilot program to incorporate imaging
technology in our disability compensation processing as well. Our pilot
program involves claims from recently separated veterans filed through
our Benefits Delivery at Discharge Program. We are receiving the
veterans' service medical records electronically and are maintaining
electronic claims folders for all claims filed under this pilot
program.
We believe that our pilot program will successfully demonstrate the
feasibility of this technology in the disability compensation program
for newly separated servicemembers. However, because of the magnitude
of the paper records we store, the extent to which we can
``paperlessly'' process claims from veterans of all periods of service
has yet to be determined. VA stores and maintains over four million
active claims files and 20 million inactive files. In addition to the
tremendous volume of records, much of the evidence VA receives includes
handwritten and often fragile documents, particularly for veterans of
earlier periods of service, which present unique challenges.
Question 5. Should VA's estimate of 800,000 claims receipts be
exceeded in Fiscal Year 2007, what measures does VA plan to take to
avoid any negative effect on the claims inventory?
Response. Increasing staffing levels is essential to handling the
current high volume of incoming claims and minimizing any negative
effect further increases might have on the claims inventory. We began
aggressively hiring additional staff in fiscal 2006, increasing our on-
board strength by over 580 employees between January 2006 and January
2007. We are continuing to accelerate hiring, adding 400 additional
employees by the end of June. Our budget submission for 2008 requests
an increase of 450 full time employees. We have also increased overtime
funding this year and recruited retired claims processors to return to
work as reemployed annuitants in order to increase decision output.
______
Response to Written Question Submitted by Hon. Barack Obama to
Hon. Daniel L. Cooper, Under Secretary for Benefits, Department of
Veterans Affairs
Question 1. DOD Coordination. I appreciated your comments about
expanding the VA's role in DOD's military pre-separation process,
although I think we need to be more systematic than simply offering a
new VA ``Claims Workshop'' to servicemembers. I've shared the deep
concern and outrage of many of my colleagues here today about the
situation at Walter Reed and how DOD manages its own disability review
process, which itself struggles under the weight of long delays and
chronic understaffing.
Question 1(a). Could you provide further comment on concrete and
more systematic steps that might be taken to coordinate or integrate VA
and DOD disability review processes to ease the transition of wounded
and recovering servicemembers?
Response. The Secretary of Veterans Affairs chaired the President's
Interagency Task Force on Returning Global War on Terror Heroes, which
reviewed VA and DOD disability benefits processes. The just-released
Task Force Report recommends development of a joint DOD/VA process for
disability benefits determinations by establishing a cooperative
Medical and Physical Evaluation Board process within the military
service branches and the VA care system.
Question 1(b). Until more systematic coordination occurs between
DOD and VA, what other steps have been taken by VA to follow GAO's
previous recommendation that regional offices use an alternative
resource for obtaining military records, prior to going through the
inadequate Joint Service Records Research Center (JSRRC), which
averages 1 year to turn around requests?
Response. VA established an intranet link to VBA-sanctioned Web
sites to assist field personnel in using research resources to expedite
the processing of post traumatic stress disorder (PTSD) claims. RO
personnel access these sites before sending an inquiry to JSRRC.
VA has organized a special help team to review the cases from JSRRC
in an attempt to reduce some of the current backlog. The special help
team is tasked with reviewing requests currently pending at JSRRC to
determine if any of the cases can be resolved with the research
resources available at the regional offices.
VA is developing a training curriculum to train regional office
personnel in the basics of military records research, which will reduce
the number of cases referred to JSRRC.
Question 2. Staffing levels. I think it's fair to say I share the
skepticism of some of my colleagues about the agency's assumptions
regarding the anticipated number of claims in Fiscal Year 2008, which
you've stated is expected to be 800,000.
Question 2(a). Could you discuss in detail the assumptions VA used
in reaching this number, especially in light of the 39 percent increase
we've seen in claims since 2000 and the growing number of returned
servicemembers from OEF/OIF? On that count alone, there are more than
631,000 discharged servicemembers who are eligible for some form of
care or benefits within the VA system.
Response. Our budget estimation model forecasts disability
compensation benefits for veterans of all periods of service using a
complex combination of historical data, current experience, workload
and performance projections, and assumptions. The model forecasts
obligations and outlays for 10 years. This method has been determined
to be a reliable method for projecting compensation costs and future
liability.
Our workload estimates for disability claims receipts are based on
a number of factors to include historical workload trend data, veteran
census data, staffing and other known factors impacting receipts. The
process has yielded adjusted workload projections within approximately
1 percent of actual receipts when viewed over the last five fiscal
years. The current wars in Afghanistan and Iraq are an important
workload variable that must continue to be considered. We believe our
process is adequately adjusted for workload changes resulting from the
wars and will allow VA to receive the resources to properly care for
this Nation's returning servicemembers.
______
Response to Written Question Submitted by Hon. Larry E. Craig to
Hon. Daniel L. Cooper, Under Secretary for Benefits, Department of
Veterans Affairs
Question 1. In recent years, thousands of claims were filed that
all sought the same relief--dual ratings for bilateral ringing in the
ears. It is my understanding that, while the courts tried to resolve
the underlying legal issue, these cases were essentially proceeding
separately up and down the system, creating workload spikes at all
levels of the process.
Question 1(a). What impact did this have at the VA regional offices
and at BVA?
Response. VA has had a longstanding policy that a veteran is
entitled to only a single evaluation for tinnitus (ringing in the
ears), whether that condition manifests itself in one ear, both ears,
or the head. Because claims for multiple evaluations for tinnitus began
appearing at the Court of Appeals for Veterans Claims (CAVC), VA, in
May 2003, amended the diagnostic code for tinnitus in the rating
schedule by adding a note, which expressly prohibits multiple
evaluations for this condition. Anticipating VA's clarification of the
rating schedule, numerous claimants began filing claims for multiple
ratings for tinnitus in the hope that the claims would be adjudicated
under what was believed to be a more liberal application of the law
allowing for multiple evaluations. On April 5, 2005, the CAVC, in Smith
v. Nicholson, held that VA's rating schedule prior to the May 2003
addition of the note allowed for multiple ratings for tinnitus. In
total, fewer than 5,000 tinnitus claims had been filed or were pending
at the Board of Veterans' Appeals (Board or BVA) when the Court
rendered its decision in Smith. On April 22, 2005, the Secretary
directed the BVA Chairman to impose a stay on all bilateral tinnitus
claims pending at the BVA that could be affected by Smith, and at the
same time, VBA stayed further processing of such claims.
The CAVC issued its judgment in Smith on April 27, 2005, and the
Secretary immediately appealed the decision to the United States Court
of Appeals for the Federal Circuit.
The Federal Circuit ruled in favor of VA's position and reversed
the CAVC decision in a June 19, 2006, decision. Following that
decision, VA proceeded to adjudicate and deny these claims. The Supreme
Court denied the appellant's petition for consideration of the Federal
Circuit's decision.
We believe that the prompt decision to stay claims affected by the
CAVC's decision in Smith served to avoid burdens on the adjudication
system and delays in adjudication of other claims, and to ensure
consistent adjudication following the resolution of the legal issues by
the Federal Circuit Court. Additionally, it prevented an unnecessary
flood of appeals to the Board of Veterans' Appeals and CAVC. As soon as
all legal challenges were exhausted, claims affected by the stay were
adjudicated expeditiously.
Question 1(b). If similar claims were either consolidated or stayed
early in the process, what do you believe would be the result?
Response. As noted above, we believe that VA's stay of tinnitus
claims was essential to managing VA's case load and ensuring efficient
and consistent action pending the resolution of the important issue on
appeal in Smith. More recently, however, in Ribaudo v. Nicholson, the
CAVC held that VA does not have the power to stay the adjudication of
cases affected by a CAVC decision that VA has appealed to the Federal
Circuit unless VA first obtains the court's permission. Although the
full scope and impact of this decision are not clear, it may have a
significant effect on VA's ability to manage its case load efficiently
in response to court decisions having broad impact on the VA
adjudication system. We continue to believe that the Secretary has the
inherent authority to stay an adjudication pending the resolution of an
important legal question in order to ensure the integrity of the
administration of a particular VA benefit and that the integrity of the
system can be preserved only if VA is able to move quickly rather than
await a CAVC decision on a stay request, which would likely require
time-consuming briefing by the parties and a written decision on the
request by the court.
Question 2. I was very pleased to learn that, in addition to
providing expedited decisions to severely injured veterans of OEF/OIF,
VA is now providing priority claims processing for all OEF/OIF
veterans.
Question 2(a). Does VA have performance goals in place for those
veterans' claims for the VA regional offices and BVA? If so, what are
they?
Response. In February 2007 VA began processing all disability
compensation and pension claims received from OEF/OIF veterans on a
priority basis. This initiative covers all active duty, National Guard,
or Reserve veterans who were deployed in the OEF/OIF theaters or in
support of the Global War on Terror (GWOT), as identified by DOD.
However, in many of these cases, all the evidence necessary to make a
decision regarding a claimant's entitlement to benefits has not been
received by VA. While we have expedited the gathering of evidence, the
scheduling of medical examinations, and the preparation of the claims
decision, this expedited process will in most cases still take a number
of months to complete. Our goal is to reduce the process to 100 days
for OEF/OIF veterans, compared with the current average of 178 days for
all veterans' claims.
Question 2(b). Would you please provide the Committee with an
update on how many of these claims VA has received since these policies
were instituted; how many of those claims have been decided and the
average time it took to render those decisions; how many are still
pending and how long on average they have been pending; how many of
these claims have been granted and how many have been denied; what
percentage have been awarded service connection with disability ratings
in excess of 10 percent; what are the nature of the claimed
disabilities and the disabilities for which service connection was
granted; and what is the accuracy rate for decisions on these claims?
If this information is not available due to data limitations, please
provide the Committee with a time frame within which that information
will be available and can be provided to the Committee.
Response. VA receives a data file from DOD identifying veterans who
were deployed in support of GWOT. We match this data file with data
from VA's information systems to track health care and benefits usage
by GWOT veterans.
The most recent update from DOD includes veterans discharged
through November 2006. This data file was compared to VA records
through February 2007. This match identified 181,966 GWOT veterans who
have filed a claim for disability benefits either prior to or following
their GWOT deployment (approximately 26 percent of 689,317 total GWOT
veterans).
Many GWOT veterans had earlier periods of service, and they filed
for and received VA disability benefits before their most recent
deployment. VBA's computer systems do not contain any data that would
allow us to attribute veterans' disabilities to a specific period of
service or deployment.
Of the 181,966 GWOT veterans who have filed a claim either prior to
or following their GWOT deployment, 136,189 were awarded service-
connected disability compensation, 17,241 were denied, and 28,536 have
claims pending. Among those awarded service-connected disability
compensation, 83,676 (61 percent) received a combined degree of
disability rating greater than 10 percent.
The charts that follow provide a breakdown of those awarded
service-connected disability by combined degree of disability and the
most frequently claimed service-connected disabilities.
GWOT Veterans Awarded Service Connection by Combined Degree of Disability
----------------------------------------------------------------------------------------------------------------
Combined Degree (in percent) Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
0......................................................... 10,551 11,380 21,931
10........................................................ 12,763 17,819 30,582
20........................................................ 6,738 13,343 20,081
30........................................................ 5,060 13,202 18,262
40........................................................ 4,195 11,290 15,485
50........................................................ 2,155 6,430 8,585
60........................................................ 2,241 6,548 8,789
70........................................................ 1,348 3,952 5,300
80........................................................ 965 2,528 3,493
90........................................................ 404 1,039 1,443
100....................................................... 719 1,519 2,238
-----------------------------------------------------
Total................................................. 47,139 89,050 136,189
----------------------------------------------------------------------------------------------------------------
Ten Most Frequent Service-Connected Disabilities for GWOT Veterans
[Both Active Duty and Reserve/Guard]
------------------------------------------------------------------------
Diagnostic Code Diagnosis Description Count
------------------------------------------------------------------------
6260.............................. Tinnitus................. 39,120
5237.............................. Lumbosacral or cervical 33,904
strain.
6100.............................. Defective hearing........ 28,589
5299.............................. Generalized, Elbow and 22,813
Forearm, Wrist, Multiple
Fingers, Hip and Thigh,
Knee and Leg, Ankle,
Foot, Spine, Skull,
Ribs, Coccyx.
9411.............................. Post-Traumatic Stress 17,644
Disorder.
5271.............................. Limited motion of the 16,907
ankle.
5260.............................. Limitation of flexion of 16,556
leg.
5242.............................. Degenerative arthritis of 12,834
the spine.
5201.............................. Limitation of motion of 12,127
arm.
7101.............................. Hypertensive vascular 12,084
disease (essential
arterial hypertension).
------------------------------------------------------------------------
We are unable to provide an accuracy rate specific to claims
received from veterans deployed in support of GWOT. VBA's quality
review program includes a random sampling across all claims filed for
compensation and pension, including those submitted by veterans of this
cohort. However, we do not isolate accuracy for any particular sub-
group of the veteran population. We also do not yet have a means of
separately track and measure timeliness of processing for GWOT claims.
A reporting system is being developed to track these claims.
Question 3. In 2005, the GAO reported that there are ``large
performance variations'' among the regional offices. For the lowest
performing offices, would you please provide a comparison of their
performance outcomes to the national performance outcomes over the past
5 years?
Response. We are providing the data requested for the 10 regional
offices currently experiencing the longest claims processing times. VBA
has taken measures to assist with the processing of veterans claims at
each of the listed facilities. For example:
The New Orleans Regional Office (RO) was severely impacted
by Hurricane Katrina. We have temporarily transferred (``brokered'')
work from this facility to other ROs with the capacity to process
additional work to minimize the impact on veterans within that
jurisdiction.
The Pittsburgh RO was recently assigned jurisdiction of
the overseas foreign workload. The processing of foreign claims takes
considerably longer, as it involves working with foreign embassies to
obtain medical examinations and other evidence. During the same period,
the RO lost a significant number of its most experienced personnel
through retirements.
The Chicago RO received an increase in incoming claims as
a result of the special Six State Outreach Initiative. We have
authorized the Chicago RO to hire additional claims processors and have
brokered work to other regional offices to better serve veterans in
this area.
To better serve the veterans residing in the Washington,
DC area, the Roanoke RO recently assumed jurisdiction for the majority
of claims previously assigned to the Washington RO.
To improve benefits delivery to veterans served by the Los
Angeles RO, jurisdiction of claims from veterans residing in Orange
County, CA, was reassigned to San Diego.
----------------------------------------------------------------------------------------------------------------
February
Average Days to Complete 2002 2003 2004 2005 2006 2007
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Nation............................ 223.4 181.5 165.5 166.8 177.1 177.4
Washington........................ 377.2 266.3 159.4 195.6 251.2 306.3
Pittsburgh........................ 147.2 112.1 167.6 186.5 219.7 260.3
New York.......................... 273.6 230.0 207.4 188.8 229.6 258.4
New Orleans....................... 166.9 150.3 156.5 153.8 269.4 249.3
Anchorage......................... 287.9 232.3 187.4 190.7 241.8 247.3
Des Moines........................ 223.0 217.7 191.4 209.5 221.4 245.5
Reno.............................. 329.6 261.8 197.6 187.6 203.9 239.9
Chicago........................... 190.6 133.4 185.6 203.7 226.5 237.9
Newark............................ 309.5 276.3 200.9 179.2 232.7 230.8
Los Angeles....................... 239.6 217.4 206.3 211.6 237.4 226.5
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Chairman Akaka. Thank you, Admiral Cooper, for your
testimony.
And now I call on the Honorable James P. Terry, Chairman of
the Board of Veterans' Appeals.
STATEMENT OF HON. JAMES P. TERRY, CHAIRMAN, BOARD OF VETERANS'
APPEALS; ACCOMPANIED BY RON GARVIN, VICE CHAIRMAN; AND STEVE
KELLER, SENIOR DEPUTY VICE CHAIRMAN
Mr. Terry. Good morning, Mr. Chairman. I greatly appreciate
the opportunity to be here today to discuss with you and the
other Members of the Committee the Board of Veterans' Appeals'
role in the VA benefits claims system.
Mr. Chairman, I am joined today by Mr. Ron Garvin, the Vice
Chairman of the BVA, to my immediate left, and Steve Keller,
the Senior Deputy Vice Chairman, two integral parts of our
leadership team, and I am delighted they could be here this
morning.
Mr. Chairman, I will address Board productivity, the
accuracy of our decisions, current issues affecting the Board,
and a review of those actions we are currently taking to
improve the claims adjudication and appeals process in my
remarks this morning.
Mr. Chairman, the Board's mission is essentially unchanged
since its establishment in 1933, and that is, of course, to
conduct hearings and consider and dispose of appeals properly
before the Board in a timely manner. The Board renders final
decisions on behalf of the Secretary in all appeals of adverse
decisions issued under a law that affects the provision of VA
benefits. These appeals most commonly arise from decisions of
VA regional offices, but they can also include those arising
from decisions by VA medical centers. Although the Board is an
appellate body, it has fact-finding authority and provides a
fresh look at the law and evidence in each case it considers.
In addition to ruling on the merits of the claim, the Board may
direct further development of the evidence and readjudication
of the claims at issue by the agency of original jurisdiction,
be it the regional office or the VAMC, if it is necessary to
fairly consider the appeal by our Board.
The Board has jurisdiction, as the Committee is well aware,
over a wide variety of issues and matters, but the vast
majority of appeals involve claims for disability compensation
benefits, and these, of course, encompass approximately 95
percent of our total caseload.
As I testified before the Committee in July of last year,
two of the Board's most important initiatives are: first, to
contain and reduce the backlog of appeals by increasing
decision productivity while maintaining high quality; and,
second, to improve timeliness and service to veterans by
eliminating avoidable remands.
Mr. Chairman, I am happy to report that we have had much
success in working toward both these goals, as demonstrated by
comparing last year's performance with that of prior years.
In Fiscal Year 1994, for example, the Board issued 22,000
decisions with 442 full-time equivalent employees, or FTEs. Our
pending caseload stood at 47,000 and was on its way to 60,000.
By Fiscal Year 1998 we had significantly improved our
productivity by issuing 38,000 decisions and holding 4,800
hearings with 483 FTEs--a much enlarged staff.
Most recently, in Fiscal Year 2006, the Board issued 39,076
decisions, but with far fewer FTEs than we had in either one of
those years. We also conducted 9,158 hearings, the highest
number ever by the Board, and almost twice as many hearings as
in 1998.
The Board's most significant challenge is to eliminate the
growing backlog with available resources. We will continue to
use our resources as efficiently and as effectively as possible
to meet this challenge. However, despite our best efforts, we
continue to receive more appeals than we are deciding. Cases
pending at the start of Fiscal Year 2006 stood at 37,000 and by
the end of the year rose to 40,000, this despite the fact that
the Board issued 4,901 more decisions in Fiscal Year 2006 than
in the preceding year.
To enable the Board to eliminate the growing backlog, the
two most important goals for the Board are to continue to
reduce avoidable remands and increase productivity.
In regard to remands, we know that veterans want timely and
correct decisions with respect to their claims for benefits.
For the Board to do that, the record must contain all necessary
evidence to decide the claim and show that all necessary
procedural protections have been provided. If the record does
not meet these requirements and the benefits sought cannot be
granted, a remand for further development by the agency of
original jurisdiction is necessary.
Remands significantly lengthen the amount of time it takes
for a veteran to receive a final decision. A remand adds about
a year to the appellate process. Remands not only delay
individual cases, but divert resources from deciding new
appeals. About 75 percent of cases remanded are returned to the
Board, which increases our workload and further degrades
timeliness; that is, we have to see the case twice. We decide
it first on the remand, and we have to look at it again and
decide it once again when it comes back.
In addition, by law we must decide the oldest cases first.
Processing newer appeals is, therefore, delayed when remanded
appeals are returned to the Board for readjudication. Hence,
eliminating avoidable remands is a goal that will provide
better service to veterans and their families and ultimately
will contribute to diminishing the growing backlog.
Since Fiscal Year 2005, we began working in concert with
Admiral Cooper and the Veterans Benefit Administration to avoid
remands to the extent possible. We--and I include Admiral
Cooper's team because they have done a magnificent job--have
made great progress in reducing avoidable remands. To
illustrate briefly, in Fiscal Year 2003 the Board issued 31,000
decisions with a remand rate of 42 percent. In Fiscal Year
2004, while the number of decisions issued increased to 38,000,
the remand rate soared to 56 percent. In Fiscal Year 2006, we
issued 34,175 decisions, but the remand rate was reduced from
56 percent to 38 percent, and that is a very, very significant
decline.
Now, we are happy to report that in Fiscal Year 2006 we
issued 39,000 decisions with a remand rate of only 32 percent,
showing the fruits of our labor. We expect to see the remand
rate hold at about that level or improve even further during
Fiscal Year 2007 as the Board begins to reach cases on our
docket that were first decided by VBA following the initiation
of its efforts to reduce avoidable remands.
By ``avoidable'' remands, we are referring to a class of
cases in which a remand could have been avoided if the case was
properly processed and reviewed in accordance with existing
laws and regulations. It is important to note that under the
current adjudication system, a certain percentage of remands
are expected for various reasons certainly beyond VA's control,
that is, both beyond the control of the VBA and the Board. For
example, some cases must be remanded to address intervening
changes in the law, as we have seen with regard to the VCAA. Or
it could be that new medical evidence is brought forward or
changes in a medical condition or other due process
considerations. On the other hand, some remands can be avoided
by careful development of the record and application of the
appropriate law, as well as close analysis of the record and
consideration of a harmless error analysis. These latter two
points are certainly within the Board's area of responsibility,
and we are working very hard to carefully find within the four
corners of every case that sufficient evidence to decide the
case and not have to ask the VBA to look at it again. And
certainly consideration of harmless error analysis is a very
important part of our work, as it is with the CAVC.
We will continue to work closely not only with VBA, but
with the Office of General Counsel and the Veterans Health
Administration to identify and track the root causes of remands
in order to provide training that will eliminate avoidable
remands. Our training efforts have been considerable to date.
Critical training sessions on remand avoidance have been held
for all veterans law judges and staff counsel. We have also
held joint training sessions with VBA, including a national
video broadcast on avoidable remands and evidence development.
We have conducted numerous sessions on a variety of medical and
legal subjects within our jurisdiction, all designed to reduce
remands and improve quality.
Additionally--and this is a very important point--each of
our Travel Boards meets on a regular basis on the last day of
the Travel Board with regional office personnel to answer
questions and discuss areas of concern. Finally, we recently
completed work with VHA and VBA on the Compensation and Pension
Examination Project, which, by improving the quality of VA
compensation medical examinations, will reduce a major cause of
remands. This is especially important in the mental health
area. Until we gain the ability to examine in a constructive
and contextual way--that is, where there is continuity in the
questioning--in order to ensure that each veteran is examined
with a contextual set of questions to perform a baseline, we
will not be able to evaluate effectively the range of
disabilities in each of our veterans. And that is what the CPEP
project has done, and we think it is very, very important.
Another important challenge for the Board is to work
closely with the 57 regional offices and the Veterans Service
Organizations to ensure that our Travel Boards are dispatched
as soon as a sufficient docket is created so that the hearing
can take place as quickly as possible.
In 2006, Mr. Chairman, in addition to the 106 scheduled
Travel Boards, 8 unscheduled trips to Montgomery, Oakland,
Columbia, Atlanta, Seattle, Detroit, Phoenix, and New York were
added after the schedule was set, for a total of 114 Travel
Boards for the year. In each one of these Travel Boards, Mr.
Chairman, we asked our judges to hold 43, approximately hour-
long, hour-plus, hearings during the course of that week. And
if it is a 2-week session, we get 86 from each judge. We try to
send at least two judges on each one of these trips. In the
case of St. Petersburg, we will be sending four this year each
month. So it is a significant number of hearings, and soon as a
docket is ready, we try to get the hearing teams out there. And
of the 106 scheduled Travel Boards last year, 5 were split
trips, which visited two ROs--Lincoln/Des Moines, Fargo/Sioux
Falls, Fort Harrison/Boise, Denver/Cheyenne, and Togus/White
River Junction. And as I mentioned, on the last day of each of
our Travel Boards we offer training and assistance by our staff
to the RO adjudication staff.
Of course, this is as much a benefit to our Board as it is
to Admiral Cooper's staff, and by that I mean every case that
is sufficiently developed that we do not have to return means
it is one-half the workload for us, as well as for the VBA
staff.
Although much has been done, we still have much to do in
increasing productivity at the Board. Within existing resources
and by way of incentives and sound management, we will continue
to improve. And these are the things we are doing on the Board,
and I would like to outline them.
In addition to eliminating avoidable remands, we are trying
to strengthen our interagency partnerships, working with
General Counsel and Admiral Cooper's staff and VHA, to improve
decision quality and joint training efforts.
We are writing shorter and more concise decisions. When I
came into the Board, one of the concerns we identified was a
need to emphasize the analysis of the facts in the context of
existing law rather than including long factual recitations in
each decision. And we have eliminated that, and we are writing
more concise, more carefully coherent and clear decisions. And
I think that really is aiding us in getting more productivity
out of each of our staff attorneys and judges.
We are also utilizing employee incentives, a strong
mentoring program, and as I mentioned, working joint training
with other organizations.
Chairman Akaka. Mr. Terry, will you please wrap up your
statement?
Mr. Terry. Yes, sir. Absolutely.
This year, certainly in 2007, we are hopeful of increasing
the funding for our organization. In the 2008 budget, the
President has suggested and certainly we expect the Congress
will support an increase of 31 FTEs among our attorney ranks,
and this will certainly make a significant difference in our
ability to better serve veterans.
Certainly, we would be delighted to take any questions you
might have, sir. Thank you for this opportunity.
[The prepared statement of Mr. Terry follows:]
Prepared Statement of Hon. James P. Terry, Chairman,
Board of Veterans' Appeals
Good morning, Mr. Chairman. It is a pleasure to be here today to
discuss with you, the Members of the Committee, and your staff, the
Board of Veterans' Appeals' (Board's) role in the VA benefits claims
system. I will address Board productivity, the accuracy of our
decisions, current issues affecting the Board, and a review of those
actions we are taking to improve the claims adjudication and appeals
process.
The Board's mission, as set forth in Chapter 71 of Title 38, United
States Code, is essentially unchanged since its establishment in 1933--
``to conduct hearings and consider and dispose of appeals properly
before the Board in a timely manner.'' The Board renders final
decisions on behalf of the Secretary on all appeals of adverse
decisions issued under a law that affects the provision of VA benefits.
These appeals most commonly arise from decisions of VA regional
offices, but also include those arising from decisions by VA medical
centers. Although the Board is an appellate body, it has fact-finding
authority and provides a fresh look at the law and evidence in each
case it considers. In addition to ruling on the merits of a claim, the
Board may direct further development of the evidence and readjudication
of the claims at issue by the agency of original jurisdiction (AOJ) if
it is necessary to fairly consider the appeal.
The Board has jurisdiction over a wide variety of issues and
matters, but the vast majority of appeals involve claims for disability
compensation benefits, such as claims for service connection, an
increased rating, or survivor's benefits, which were denied at the VA
regional office level. The Board's objective is to produce well-
reasoned, accurate, timely, and fair appellate decisions in all the
cases that come before us.
As I testified before this Committee on July 13, 2006, two of the
Board's most important initiatives are (1) to contain and reduce the
backlog of appeals by increasing decision productivity, while
maintaining high quality, and (2) to improve timeliness and service to
veterans by eliminating avoidable remands in order to issue more final
decisions.
I am happy to report that we have had much success in working
toward both these goals, as demonstrated by comparing our past
performance with that of recent years.
In Fiscal Year 1994, the Board issued 22,045 decisions with 442
full-time equivalent employees (FTE). Our pending caseload stood at
47,148, and was on its way to 60,000. By Fiscal Year 1998, we had
significantly improved our productivity by issuing 38,886 decisions and
holding 4,875 hearings, with 483 authorized FTE.
Most recently, in Fiscal Year 2006, the Board issued 39,076
decisions. We also conducted 9,158 hearings, the highest number ever by
the Board, and almost twice as many hearings as in 1998.
The Board's most significant challenge for the future is to
eliminate the growing backlog. We will continue to use our resources as
efficiently and effectively as possible to meet this challenge.
However, despite our best efforts, we continue to receive more appeals
than we are deciding. Cases pending at the start of Fiscal Year 2006
stood at 37,539, and by the end of the year rose to 40,265. This is
despite the fact that the Board issued 4,901 more decisions in Fiscal
Year 2006 than in the previous year.
To enable the Board to eliminate the growing backlog, the two most
important goals for the Board are to continue efforts to reduce
avoidable remands and increase productivity. In regard to remands, we
know that veterans want timely and correct decisions with respect to
their claims for benefits. For the Board to do that, the record must
contain all evidence necessary to decide the claim and show that all
necessary procedural protections have been provided. If the record does
not meet these requirements, and the benefits sought cannot be granted,
a remand for further development by the AOJ is necessary.
Remands significantly lengthen the amount of time it takes for a
veteran to receive a final decision. A remand adds about a year to the
appellate process. Remands not only delay individual cases, but divert
resources from deciding new appeals. About 75 percent of cases remanded
are returned to the Board, which increases our workload and further
degrades timeliness. In addition, because by law we generally must
decide the oldest cases first, processing of newer appeals is delayed
when remanded appeals are returned to the Board for readjudication.
Hence, eliminating avoidable remands is a goal that will provide better
service to veterans and their families and, ultimately, will contribute
to diminishing the growing backlog.
Since Fiscal Year 2005, when we began working concertedly with the
Veterans Benefit Administration (VBA) to avoid remands to the extent
possible, we have made great progress in reducing avoidable remands. To
illustrate briefly, in Fiscal Year 2003, the Board issued 31,397
decisions, with a remand rate of 42.6 percent. In Fiscal Year 2004,
while the number of decisions issued increased to 38,371, the remand
rate soared to 56.8 percent. In Fiscal Year 2005, we issued 34,175
decisions of which 38.6 percent were remanded in whole or part. We are
happy to report that in Fiscal Year 2006, we issued 39,076 decisions,
with a remand rate of only 32 percent. We expect to see the remand rate
to hold its own or improve even further during Fiscal Year 2007, as the
Board begins to reach cases on our docket that were first decided by
VBA following the initiation of its efforts to reduce avoidable
remands.
By ``avoidable'' remands, we are referring to a class of cases in
which a remand could have been avoided if the case was properly
processed and reviewed in accordance with existing laws and
regulations. It is important to note that under the current
adjudication system a certain percentage of remands are expected for
various reasons beyond VA's control. For example, some cases must be
remanded to address intervening changes in the law, new medical
evidence, changes in medical condition, or other due process
considerations. On the other hand, some remands can be avoided by
careful development of the record and application of the appropriate
law, as well as close analysis of the record and consideration of a
harmless error analysis.
We continue to work closely not only with VBA, but with the Office
of General Counsel (OGC) and the Veterans Health Administration (VHA)
to identify and track the root causes of remands in order to provide
training that will eliminate avoidable remands. Our training efforts
have been considerable. Several training sessions on remand avoidance
have been held for all Veterans Law Judges (VLJs) and staff counsel. We
have also held joint training sessions with VBA, including a national
video broadcast, on avoidable remands and evidence development. We have
conducted numerous sessions on a variety of medical and legal subjects
within our jurisdiction--all designed to reduce remands and improve
quality. Additionally, each of our Travel Boards has met with regional
office (RO) personnel to answer questions and/or discuss shared areas
of concern. Finally, we are working with VHA and VBA on the
Compensation and Pension Examination Project (CPEP), which, by
improving the quality of VA compensation medical examinations, will
reduce a major cause of remands.
Another important challenge for the Board is to work closely with
the 57 ROs and the Veterans Service Organizations to ensure that Travel
Boards are dispatched as soon as a sufficient number of cases that are
nearing their place on the Board's docket are ready for hearing. In
2006, in addition to 106 scheduled Travel Boards, 8 unscheduled trips
to Montgomery, Oakland, Columbia, Atlanta, Seattle, Detroit, Phoenix,
and New York were added after the ROs provided notice that the docket
was ready, for a total of 114 Travel Boards for the year. Of the 106
scheduled Travel Boards, 5 were split trips which visited two ROs
(Lincoln/Des Moines, Fargo/Sioux Falls, Ft. Harrison/Boise, Denver/
Cheyenne, and Togus/White River Junction). On the last day of each of
our Travel Boards, we offer training and assistance by our staff
attorneys to the RO adjudication staff. This is as much of a benefit to
the Board as to the RO staff, if it precludes one case from being
returned to the RO from the Board via remand for further development.
Although much has been done, we still have much to do in increasing
productivity at the Board. Within existing resources, and by way of
incentives and sound management, we will continue to improve by:
(1) Eliminating avoidable remands;
(2) Strengthening our intra-agency partnerships: Our joint training
efforts with VBA, OGC, and VHA are improving decision quality and
reducing remands;
(3) Writing shorter and more concise decisions: We continue to
train and encourage our VLJs and counsel to write clear, concise,
coherent, and correct decisions;
(4) Utilizing employee incentive, mentoring and training programs:
A number of new programs have been introduced to increase employee
motivation and satisfaction, as well as to increase productivity and
decision quality;
(5) Making judicious use of overtime: We will use overtime within
existing resources to enhance productivity;
(6) Increasing our use of paralegals: We will increase the use of
our paralegals for non-decisional support activities, freeing up our
legal staff to decide appeals;
(7) Providing improved online legal research tools and analytical
frameworks to aid timely and correct decision production;
(8) Succession Planning: The Board will continue its rigorous
associate counsel recruitment program to hire the best and brightest
attorneys available;
(9) Improve Quality: The Board will use its quality review process
to identify areas of concern that require follow-up training;
(10) VLJs will draft some decisions, in addition to reviewing and
revising drafts prepared by staff counsel; and
(11) Aggressive recruiting and training program to ensure full
productivity by maintaining our authorized staffing levels.
We believe these measures will reduce the backlog and shorten the
time it takes for a veteran to receive a fair, well-reasoned Board
decision. In addition to the Board's increases in productivity, we have
also improved decision quality. In Fiscal Year 2005, the Board's
decision quality was 89 percent, based on 34,175 total decisions
issued. We are proud to report that in Fiscal Year 2006, not only did
the Board increase its total decision output by 4,901 cases, but the
Board's decision quality increased to 93 percent. By decision quality,
we mean that there were no substantive or procedural errors that would
have resulted in the case being reversed or remanded to the Board by
the United States Court of Appeals for Veterans Claims. Into the second
quarter of Fiscal Year 2007, we find that this enhanced decision
quality has been maintained.
Although there was an increase in quality and quantity, the Board
saw its pending caseload grow significantly in 2006. As I briefly noted
earlier, in addition to issuing 39,076 decisions in Fiscal Year 2006,
we conducted 9,158 hearings, an increase of 582 hearings over the total
held in Fiscal Year 2005 and the most ever held by the Board. However,
the number of cases pending before the Board at the end of Fiscal Year
2006 was 40,265, which was close to a 3,000 case increase over the
37,539 cases that were pending at the end of Fiscal Year 2005. This
increase in pending cases occurred despite the increase in the number
of decisions issued of nearly 5,000 over the previous year--an increase
notwithstanding the reduction in our authorized FTEs from 440 in Fiscal
Year 2005 to 434 in Fiscal Year 2006. As of today's date, we have more
than 28,000 cases with a pending request for a Board hearing, the
highest number ever. Of these cases more than 8,000 are actually ready
for a hearing. Our 114 plus Travel Boards in Fiscal Year 2007 should
sharply reduce the number of pending hearings.
Although we continue to operate at the 2006 level, our attorneys
and judges are significantly ahead of last year's pace in terms of
productivity. I attribute this increased productivity to superb
leadership in each of our Decision Teams, an unparalleled in-house
training and mentoring program, and to the quality of our line
attorneys in drafting complex, quality decisions in an accurate and
timely manner.
As you know, we have high expectations for our counsel and Veterans
Law Judges. We ask each of our counsel to write more than three
complete draft decisions a week, and each of our line Judges to review,
modify as necessary, and sign approximately 19 decisions a week. Over
the course of the year, the Board's fair share standards call for our
attorneys to complete a total of 156 timely decisions of high quality,
and for each of our line Judges to complete and sign 752 decisions. In
addition, each Judge is expected to complete at least 3 week-long
Travel Board trips per year, in which they hear cases at one of the 57
ROs. A senior counsel accompanies the Judges during these Travel Board
trips to assist in the conducting of the hearings and to provide
training and other requested assistance to the RO staff.
In conclusion, we will continue working to develop new and creative
solutions to the challenges we face in order to fulfill our statutory
mission to hold hearings and provide timely, high quality decisions to
our Nation's veterans and their families.
I am pleased to answer any questions you or your colleagues may
have.
______
Response to Written Questions Submitted by Hon. Daniel K. Akaka
to Hon. James P. Terry, Chairman, Board of Veterans' Appeals
Question 1. Please update the Committee on the status of the
Board's efforts to move toward electronic records in BVA adjudication?
Response. The Board of Veterans' Appeals (BVA or Board) reviews an
appellate record that it receives from the agency of original
jurisdiction, usually a regional office of the Veterans Benefits
Administration (VBA). Aside from an occasional audio or video tape or
microfiche film submitted in the record, almost all records reviewed by
the Board are paper documents contained in an appellant's claims file
or other special purpose folder, such as an education or vocation
rehabilitation benefits folder. These files are often voluminous. They
may contain records spanning decades and typically include records
generated before, during and after the veteran's period of military
service. To convert these often massive paper files into electronic
form is an enormous undertaking and one that is well beyond the
resources and expertise of the Board.
In addition, as you note in the following question, the U.S. Court
of Appeals for Veterans Claims (CAVC or Court) requires the submission
of a paper record on appeal. As a result, any electronic copies of
documents that are part of the appellate record would have to be
printed in order to be received by the CAVC.
While we have no program to generate or convert paper documents to
electronic records, we are actively using technological advancements to
improve our ability to accomplish our statutory mission to hold
hearings and consider and dispose of appeals in a timely manner. These
efforts include the provision of videoconference hearings, which use a
system of digital recording and transmission of the hearing
``transcript.'' We also employ extensive electronic legal research
tools that have become essential in assisting the adjudication of
decisions on appeal. In addition, a number of years ago the Board
created a paperless system for retaining and filing attorney fee
agreements that are required to be filed with the Board.
Question 2. Rule Nine of the Court of Appeals for Veterans Claims'
Rules of Practice and Procedure requires that paper copies of all
documents and evidence relevant to an appeal be transmitted to the
Court. Do you believe that repeal of this rule and the allowance of
electronic records would expedite the referral of appeals to the CAVC?
Response. As noted above, the Board does not have the ability to
convert the massive amount of paper documents it receives into
electronic form. If, at some point in time, electronic records were
generated by the originating agency and supplemented by the Board, such
a change in the Court's rules may well have an ameliorative effect on
the timeliness of processing of appeals at the CAVC. The submission of
an electronic record would obviate the need for photocopying and
collating a massive number of documents. However, absent a change in
the Court's rules, the Secretary would still have the burden of
designating the record on appeal. I understand that the Court is
considering alternatives to the current process for designating the
record on appeal that would expedite the processing of cases at the
Court. Under this revised process, however, paper records would still
be employed.
Question 3. How much training does a Veterans Law Judge undergo per
year? What specific training is provided?
Response. The Board devotes a substantial amount of time and
resources to providing training to our veterans law judges (VLJs) and
staff counsel. Besides the Department of Veterans Affairs (VA)-wide
periodic training on Cyber Security, the Privacy Act, the No FEAR Act,
Sexual Harassment, and Federal Employee Ethics Requirements, a wide
variety of training is provided to enable the Board to produce high
quality decisions in a timely manner. The Board has a full-time
Training Coordinator who, in close coordination with the Board's Chief
Counsel for Policy, is responsible for scheduling and organizing Board-
wide training events, which usually average about twice a month.
Training on various topics related to computer-assisted legal research
also is periodically scheduled by the Board's librarian. Additionally,
the Board sends individually selected employees to management and
leadership training courses provided at the Office of Personnel
Management (OPM) Management Development Centers and the Federal
Executive Institute.
With respect to the Board-wide training provided to VLJs and
attorneys, the types of training can be broken down into the following
five categories: critical skills training; current issues and
competency training; specialized skills training; leadership/management
development training; and mandatory training. Some of the types of
training provided within each of these categories include:
critical skills training
Writing--Training is periodically provided to upgrade
writing skills. At the beginning of 2006, the Board initiated a writing
skills program entitled the ``4-Cs,'' short for clear, concise,
coherent, and correct decision writing. The purpose of the training was
to address a number of matters, including the increasing length of
Board decisions due, in part, to long recitations of fact and
boilerplate summaries of the law, and reasons or bases deficiencies in
Board decisions.
Legal Research--Initial training is offered to new
employees and product upgrade/enhancement training is offered on an
ongoing basis to the entire attorney and VLJ staff concerning the use
of computer-assisted legal research tools.
current issues and competency training
Educational Seminars--Learning seminars of a medical and
legal nature are offered monthly (approximately 10 per year). Lectures
from Board staff range from 1 hour to 1 hour and a half in length.
Participation is voluntary. Examples of some recent topics covered are:
Adjudicating Gulf War Claims; Rating Residuals of Gunshot Wounds;
Adjudicating Medical Reimbursement Claims; Rating Eye Disorders;
Understanding Military Records and Awards; Adjudicating Section 1151
Claims; Adjudicating Section 1318 Claims; and Introduction to Medical
Terminology.
Grand Rounds--Periodic ``Grand Rounds'' training sessions
are provided for all VLJs and staff counsel. Attendance is required.
The purpose of these training sessions is to keep the legal staff
current with continuing changes in the law, to address areas of
weakness in Board decision quality, and to address current ``hot''
issues.
specialized skills training
Income Verification Match--This training is required for
selected attorneys and VLJs who handle cases that include protected tax
information.
leadership/management development training
Office of Personnel Management Training
Federal Executive Institute
Leadership VA
VA Learning University sponsored leadership training
mandatory training
Privacy Policy
Cyber Security Awareness
Federal Employee Antidiscrimination and Retaliation Act
(No FEAR)
Prevention of Sexual Harassment
Ethics
Besides Board-wide training, the Board's four decision teams also
periodically schedule internal team training events on a variety of
issues.
Question 4. How much training does a decision team attorney undergo
per year? What specific training is provided?
Response. As discussed in the previous answer, predominantly the
same type of training is provided to both the Board's VLJs and staff
counsel. However, there are some specific types of additional training
that are provided solely to the newly hired attorney staff.
On a Board-wide basis, the following training is provided to new
staff counsel on both legal and medical matters:
Introduction to the Board of Veterans' Appeals (BVA 101)--
This training introduces new employees to the structure, operations and
policies of the Board. Two-hour course.
Basic Veterans' Law (BVA 201)--This course is an
introduction to the law of the U.S. Court of Appeals for Veterans
Claims and the relevant rulings of the U.S. Court of Appeals for the
Federal Circuit. Twelve-hour course.
Computer Skills Training (CST) Course--This training
provides the attorney with computer information and tips to enable more
efficient drafting of decisions using the Board's computer system. One
hour course.
Global Training--This training provides an overview of the
Board's management and administration process. Attorneys have the
opportunity to learn firsthand about the journey of a case file once it
is received at the Board. Three-hour course.
Mentoring--This is a 3-month training period where the
attorney is tutored on all aspects of decision preparation by an
assigned senior Board counsel.
Adjudication Academy--This is a 2-day collaborative
offsite effort by the Veterans Health Administration (VHA), VBA and the
Office of General Counsel to provide an opportunity for new BVA
attorneys to learn about the role these administrations and staff
offices have in the adjudication process. This course is conducted
approximately once a year in Baltimore.
Besides Board-wide training, the Board's four decision teams also
schedule internal team training events for new attorney staff and
summer interns on an ``as needed'' basis. During 2006, the teams
provided training on a wide variety of topics, including the VCAA and
Basic Service Connection Concepts; Increased Ratings; Quality Review at
the Board; the Handling of Multi Issue/Complex Cases; Efficient
Handling of Cases; Career Development; Hearing Loss; Personal
Experiences of BVA Veterans; Research Tools; a presentation by Disabled
American Veterans national VSO representatives; Conducting Board
Hearings; Medical Opinion Requests; the Board's Rules of Practice and
Procedure; BVA Handbooks; and VA Benefits Overview.
Question 5. As of February 2007, flexi-place was available for up
to 48 high-achieving attorneys. What are your plans to expand this
program?
Response. The Board plans to expand its Flexiplace program to a
maximum of 88 attorneys, beginning on or about July 1, 2007. The
Flexiplace program was originally only available to full- time
attorneys, but has been open to part-time employees since September
2006, a feature that will continue when the program is expanded.
Employee eligibility depends upon a variety of factors, but all
employees selected to participate in the expanded Flexiplace program
will be required to demonstrate high levels of achievement as a
prerequisite, and must maintain such performance in order to remain in
the program.
In terms of performance, the Board's Flexiplace program has
resulted in increased individual production for participants, which in
turn has contributed significantly to the Board's overall production of
decisions. The Board's performance standards require that all Board
attorneys produce a minimum of 156 credits per year (credits are
roughly equivalent to decisions). We have found that those Flexiplace
participants who started the program on or after December 30, 2005,
were able to successfully produce at least 170 credits per year, while
maintaining acceptable or better quality. We plan to continue these
requirements for all participants selected when the expansion of the
program is effectuated.
Only those employees who have proven to be dependable, independent,
and highly motivated are selected for participation in the program. In
addition to contributing significantly to our statutory mission by
increasing productivity in order to stem the growth of the backlog and
improve timeliness, our Flexiplace program has proven to be a very
attractive and important recruitment and retention tool. Some of our
best and brightest attorneys have stayed with us or chosen employment
with the Board because of this and other efforts to make the Board an
employer of choice.
In regard to information and data security, Flexiplace participants
are issued VA laptops that are specially encrypted and regularly
serviced by VA IT personnel to secure all sensitive information. The
technology allows for secure communication between Flexiplace
participants at home and personnel or data located at the office.
Flexiplace participants transport veterans' case files and draft
decisions by specially designed, locking carrying cases issued by VA.
Flexiplace participants must also have a home office where their work
is performed and data can be secured. The Board conducts periodic home
visits of the participants to verify that they are in compliance with
all Flexiplace requirements.
The expansion of the Flexiplace program is an enthusiastically
anticipated development at the Board and is expected to generate a
significant increase in the Board's overall ability to accomplish its
mission.
______
Response to Written Question Submitted by Hon. Barack Obama
to Hon. James P. Terry, Chairman, Board of Veterans' Appeals
Question 1. Mr. Terry, thank you for covering steps that are
already underway in the VA to reduce the backlog of claims and shorten
turnaround times. Beyond staffing and funding levels, which many of us
think are currently inadequate under the proposed VA budget for FY
2008, what do you think are the two most important measures you've
outlined in reducing the backlog? In reducing the turnaround time?
Response. Eliminating avoidable remands and using a variety of
methods to increase decision productivity are our two most important
efforts to stem the growth of the backlog and, at the same time,
improve the timeliness of the appeals process.
Remands significantly contribute to the backlog and degrade
timeliness. The reworking of an appeal at the regional office, on the
average, adds about a year to the processing of an appeal. The time and
resources consumed by developing and readjudicating the appeal, both at
the Board and at the regional offices, is diverted from processing
original claims and appeals. As about 75 percent of BVA remands are
eventually returned to the Board for readjudication, they become a
significant addition to the appellate workload. Moreover, as remands,
by law, require expeditious handling and generally have older docket
numbers, they displace ``newer'' appeals on the Board's docket and add
to the already long wait for justice that our veterans and their
families now experience.
While some remands are necessary and advisable, our joint efforts
with VBA to eliminate those remands that we justifiably can avoid will,
over time, make a significant impact in curtailing the backlog and the
delays within the entire adjudication system. We have begun to make
important progress in this area, bringing the remand rate down from
56.8 percent in Fiscal 2004, to 38.6 percent in Fiscal 2005, and to
32.0 percent in Fiscal 2006.
Increasing decision productivity while maintaining high quality is
the other mainstay of our efforts to stem the backlog and improve
timeliness. We have met with success by the implementation of a number
of measures, each of which has contributed incrementally to achieve
this goal. These measures include fair but challenging performance
standards for our VLJ and staff counsel, performance incentives,
training and mentoring, efforts for improved and clearer and concise
decision writing, and encouraging our judges to draft decisions
whenever possible. With these measures, the Board was able to issue
39,076 decisions and hold 9,158 hearings in Fiscal 2006 with our
available resources. We believe that these efforts will continue to
make inroads in stemming the growth or reducing the backlog.
Question 2. You mentioned ``considerable'' training efforts to
tackle the issue of avoidable remands, including sessions for Veterans
Law Judges and joint training sessions with VBA. Expanding these
efforts seems like one of the keys to reducing the number of these
cases. Could you--or Admiral Cooper, or both--comment more specifically
on the scope of these training efforts to date at the regional offices:
how many sessions and in how many regional offices, how long do they
last, who attends, and who is required to attend?
Response. With respect to the Board's participation in regional
office training, the Board conducts training for regional office
adjudication staff both during travel board visits and by way of
videoconference. Over the past few years, we have conducted numerous
such sessions of varying length on a variety of medical and legal
subjects designed to reduce remands and improve quality.
During travel board trips, the attorney staff who are sent to
assist the VLJs, as well as some of the VLJs, meet with regional office
staff to answer questions, discuss shared areas of concern, and provide
training when requested. Such interactions are mutually beneficial to
both organizations in reducing remands and ensuring cases are fully and
properly developed and processed.
Based on the reports received from 28 travel boards (out of 30)
conducted so far during Fiscal 2007, Board attorneys have provided
informal training to the regional office staff during all trips.
Informal training consists of case reviews, determinations of adequacy
of development, discussions on recent CAVC cases, discussion on trends
noticed in hearing cases, and tips to reduce avoidable remands.
Informal training is usually provided on a one-on-one basis with rating
veterans service representatives (RVSRs), decision review officers
(DROs), and adjudication managers. Formal training, on the other hand,
was provided during 17 of the 28 trips, or 61 percent of the time.
While training topics vary, the most common topics addressed by Board
staff so far this year address matters related to post traumatic stress
disorder (PTSD) service connection claims, VCAA notification, and the
discussion of recent CAVC decisions. A complete list of the training
topics addressed and at which particular regional offices is enclosed
(Enclosure 1).
[Enclosure 1 follows:]
Enclosure 1
----------------------------------------------------------------------------------------------------------------
RO FY 2007 Training Topics Informal Assistance
----------------------------------------------------------------------------------------------------------------
Boston.................................. Proper dev. of PTSD claims; recent CAVC Yes
decisions; complete dev. to reduce
remands; adequacy of medical evid.
Albuquerque............................. Rating knee disabilities, verification of Yes
combat service.
Muskogee................................ None...................................... Yes
St. Petersburg.......................... Adequacy of VCAA notice; avoidable remands Yes
Waco.................................... None...................................... Yes
Winston-Salem........................... Avoidable remands......................... Yes
Columbia................................ None...................................... Yes
Houston................................. Development and adjudication of PTSD Yes
claims; new and material evidence; CUE.
San Antonio............................. None...................................... Yes
Nashville............................... None...................................... Yes
Montgomery.............................. VCAA compliance; when is an exam required; Yes
rating of spine disabilities; rating of
cardiovascular disabilities.
Atlanta................................. Recent CAVC decisions; remand trends...... Yes
Detroit................................. Inferred issues; due process in contested Yes
claims.
Indianapolis............................ Rating disabilities of the eyes; rating
knee disabilities; recent CAVC cases
including Haas.
Newark.................................. Development of PTSD stressors; heart Yes
disease secondary to PTSD; VCAA notice
esp. Kent, other recent CAVC cases.
Portland................................ Dev. of PTSD claims; recent CAVC Yes
decisions; VCAA notice; avoidable
remands; through claim development;
adequacy of medical evidence; severance
of service connection; rating reductions.
Philadelphia............................ VCAA notification esp. Kent............... Yes
New York................................ None...................................... Yes
Phoenix................................. Role of the Board; recent CAVC cases esp. Yes
Haas and Ribaudo; proper weighing of
evidence; DeLuca analysis.
St. Petersburg.......................... None...................................... Yes
Little Rock............................. Adequacy of VA exam reports............... Yes
New Orleans............................. None...................................... Yes
Atlanta................................. None...................................... Yes
Jackson................................. Adjudicating PTSD claims; recent CAVC
decisions esp. Haas, Ribaudo, and Kent;
avoidable remands.
Waco.................................... None...................................... Yes
St. Petersburg.......................... Adjudication of PTSD claims; Gulf War Yes
claims; VCAA; secondary service
connection.
Cleveland............................... None...................................... Yes
Winston-Salem........................... Adjudication based on pre-discharge exam; Yes
reserve duty vs. active duty; recent CAVC
decisions esp. Deshotel.
----------------------------------------------------------------------------------------------------------------
For purposes of comparison, based on the reports received from 109
travel boards (out of 114) that were conducted during Fiscal 2006
(counsel did not accompany the VLJs on some of the trips), Board
attorneys provided informal training during all 109 trips. With respect
to formal training, this occurred during 62 of the 109 trips, or 57
percent of the time. The most common training topics addressed were
PTSD service connection claims, VCAA notification, discussion of recent
CAVC decisions (Kent, Dingess, Haas), when a VA examination is needed,
application of the presumptions of aggravation and soundness, and the
assignment of effective dates. A complete list of the training topics
addressed and at which particular regional offices is enclosed
(Enclosure 2).
[Enclosure 2 follows:]
Enclosure 2
------------------------------------------------------------------------
FY 2007 Training Informal
RO Topics Assistance
------------------------------------------------------------------------
Montgomery.................... Active duty for Yes
training vs. inactive
duty; verifying PTSD
stressors; rating
hypertension; SC
hepatitis claims.
St. Paul...................... Earlier effective Yes
date; informal claims.
Atlanta....................... Remand reasons........ Yes
Albuquerque................... Evaluating back Yes
disabilities;
reducing avoidable
remands.
Phoenix....................... None.................. Yes
Pittsburgh.................... None.................. Yes
Muskogee...................... None.................. Yes
Oakland....................... VA exam reports; Yes
recent CAVC
decisions; PTSD
claims; reasons for
remand.
New York...................... None.................. Yes
Waco.......................... None.................. Yes
Seattle....................... Proper framing of Yes
issues on appeal;
multiple theories of
entitlement;
development of claims.
Huntington.................... None.................. Yes
Nashville..................... Personal assault PTSD. Yes
Detroit....................... None.................. Yes
St. Petersburg................ None.................. Yes
Winston-Salem................. None.................. Yes
Columbia...................... None.................. Yes
Montgomery.................... ``Remand proofing''; Yes
VCAA; CAVC case law
on service
incurrence; policy
about PTSD and CAD
disorders; DeLuca.
Boston........................ None.................. Yes
Philadelphia.................. None.................. Yes
Jackson....................... Reducing remands...... Yes
Little Rock................... None.................. Yes
Atlanta....................... Reduction of remands; Yes
recent case law (to
include VCAA).
St. Petersburg................ CAVC 1151 decisions; Yes
Haas decision.
Houston....................... None.................. Yes
Newark........................ None.................. Yes
St. Louis..................... revised regulations; Yes
VCAA; remands; 1151;
effective dates;
medical examinations
of RO employees.
St. Paul...................... Due process in 4.29 Yes
reductions; SC
multiple sclerosis;
sufficient PTSD
stressors; DeLuca
opinions; adequacy of
opinions in hearing
loss; evidence in
TDIU claims; VA
speculative opinions;
avoiding Colvin
violations; weighing
of risk factors in
hepatitis C cases.
Los Angeles................... Questions about Yes
specific fact
scenarios and Board's
organization and
structure.
San Antonio................... Development of SOC's Yes
and VCAA.
Portland...................... None.................. Yes
St. Petersburg................ None.................. Yes
Waco.......................... None.................. Yes
Oakland....................... Avoidance of remands; Yes
Board and CAVC
trends; VCAA; when to
obtain examinations;
PTSD stressor
development; PTSD
personal assault
claims; 1151 claims.
Indianapolis.................. Avoidance of remands; Yes
presumption of
soundness and
aggravation.
Columbia...................... proper framing of Yes
issues on appeal;
multiple theories of
entitlement; and the
development of claims.
San Diego..................... Reduction of remands; Yes
Dingess/Hartman
impact; when to
obtain an examination
or opinion; VCAA
notice.
Seattle....................... Dingess/Hartman; PTSD Yes
(stressor development
and IR); CUE;
secondary service
connection; reduction
of remands.
Salt Lake City................ Function of BVA;
Dingess; when nexus
opinions are needed;
aggravation claims;
DeLuca; the role of
CAVC.
Reno.......................... Reduction of remands; Yes
BVA functioning.
Wichita....................... None.................. Yes
St. Petersburg................ Mayfield and Haas..... Yes
Albuquerque................... Reasons for remands; Yes
Mayfield, Haas; when
to request exams and
opinions.
Boston........................ None.................. Yes
Providence.................... Rating psychiatric and Yes
TDIU claims.
Little Rock................... None.................. Yes
Cleveland..................... None.................. Yes
Waco.......................... None.................. Yes
Winston-Salem................. None.................. Yes
Anchorage..................... None.................. Yes
Denver........................ None.................. Yes
Las Vegas..................... None.................. Yes
Chicago....................... None.................. Yes
San Juan...................... Complications of Yes
diabetes; PTSD;
rating spinal
disorders; DeLuca;
National Guard
members; avoidance of
remands.
Jackson....................... Avoidance of remands; Yes
lifting of Smith
stay; VCAA; Kent;
Dingess.
St. Petersburg................ Avoidance of remands; Yes
focus on when to
request exams and
opinions.
Waco.......................... None.................. Yes
Louisville.................... VCAA compliance; Yes
rating knees.
Ft. Harrison.................. reasonable doubt/ Yes
equipoise; rating
mental and joint
disorders; rating
hearing loss;
difference between
inferred and
intertwined claims;
VCAA; verifying PTSD
stressors; Haas;
effective dates;
adequacy of exams;
development of
evidence.
Houston....................... Avoidance of remand; Yes
impact of CAVC cases
(Kent).
San Antonio................... None.................. Yes
Muskogee...................... Dingess/Hartman; ways Yes
to reduce Manlicon
remands; when to
request VA exams or
request opinions.
Newark........................ None.................. Yes
Boston........................ VCAA.; need to Yes
consider GAF scores.
Buffalo....................... Kent compliance; use Yes
of diagnostic codes,
particularly the knee.
Hartford...................... Cue; rating knees..... Yes
Atlanta....................... Common reasons for Yes
remand; BVA's
attempts to avoid
remands.
Roanoke....................... Impact of Mayfield, Yes
Kent, Dingess/
Hartman; when
examiner must review
the file for an exam;
when veteran can
waive development.
Detroit....................... None.................. Yes
New York City................. Dingess/Hartman; Yes
weighing evidence;
presumption of
soundness and
aggravation; judicial
review.
Oakland....................... Tips on ``remand Yes
proofing'' decisions;
Dingess/Hartman; duty
to obtain Federal
records; waiver of
duty to assist; Smith.
Montgomery.................... PTSD development; when Yes
exams are needed.
St. Petersburg................ None.................. Yes
Waco.......................... None.................. Yes
Manila........................ effective dates; CUE.. Yes
White River Jun............... None.................. Yes
Columbia...................... None.................. Yes
Los Angeles................... None.................. Yes
Nashville..................... Lifting of Smith stay; Yes
Kent and Dingess
responses; when to
obtain exams and
opinions.
New York City................. Mayfield and Kent..... Yes
St. Petersburg................ None.................. Yes
New Orleans................... Dingess compliance.... Yes
Huntington.................... Avoidance of remands; Yes
claim development;
proper framing of
issues; multiple
theories of
entitlement; adequacy
of medical evidence.
Lincoln....................... None.................. Yes
Atlanta....................... Avoidance of remands; Yes
VCAA compliance
(Kent, Dingess,
Pelegrini; exams and
opinions.
Houston....................... None.................. Yes
San Antonio................... None.................. Yes
Philadelphia.................. VA claims/appeals Yes
processing issues.
Seattle....................... Recent CAVC decisions Yes
incl. Haas and
McLendon; obtaining
SSA records; FTR for
exam; obtaining
relevant medical
evidence.
Wilmington.................... Reducing avoidable Yes
remands; reasonable
doubt doctrine; PTSD
stressor development;
evaluation of PTSD.
New York...................... None.................. Yes
Newark........................ PTSD stressor Yes
development; when a
VA exam is needed.
Denver........................ None.................. Yes
San Diego..................... Recent CAVC decisions Yes
incl. Kent Haas,
Dingess and Rudd.
Wichita....................... When to obtain a VA Yes
medical opinion; VCAA
compliance.
St. Petersburg................ None.................. Yes
Oakland....................... Recent CAVC decisions. Yes
Phoenix....................... Overview of BVA; Yes
current BVA stats;
reducing avoidable
remands; PTSD
stressor development;
obtaining adequate
medical opinions.
Waco.......................... None.................. Yes
Milwaukee..................... Credibility and Yes
competence of lay
evidence; waiver of
VCAA.
St. Petersburg................ Adjudicating PTSD Yes
claims; aggravation;
presumption of
soundness; Haas;
Colvin; when to
request a VAX.
Cleveland..................... None.................. Yes
Phoenix....................... VCAA compliance; PTSD Yes
stressor development;
DeLuca; Haas;
reducing avoidable
remands.
Detroit....................... Gulf War claims; Yes
adjudicating Iraq
PTSD claims;
effective dates;
aggravation.
Atlanta....................... Recent CAVC decisions Yes
incl. Deshotel,
McLendon, Kent,
Dingess.
Cleveland..................... Recent CAVC decisions Yes
incl. Kent, Haas,
Rudd; impact of new
definition of
psychosis; reducing
avoidable remands.
Little Rock................... SC PTSD claims incl. Yes
combat and non-combat
stressors; need for a
VA exam; recent CAVC
decisions incl. Haas,
McLendon.
Portland...................... Definition of Yes
chronicity; asbestos
claims; inactive duty/
active duty claims;
EED claims.
Fargo/Sioux Falls............. VCAA compliance; PTSD Yes
stressor
verification;
personal assault PTSD
claims; recent CAVC
decisions.
Montgomery.................... active duty training/ Yes
inactive duty;
verifying PTSD
stressors; rating
hypertension; SC
hepatitis.
St. Louis..................... Remand reasons; Yes
reducing avoidable
remands; VCAA
compliance; when to
get a VA exam.
Columbia...................... PTSD esp. Pentecost; Yes
presumption of
soundness;
aggravation of
disabilities.
New York...................... None.................. Yes
St. Paul...................... Effective dates; Yes
informal claims.
------------------------------------------------------------------------
Besides training conducted during travel board trips, the Board
also provides training to the regional offices by way of
videoconference. This training is conducted by the Board's four
decision teams to regional offices located in that team's
geographically assigned region of the country. This type of training
was conducted fairly frequently in the past, but less so in recent
years. However, the Board has recently started to see an upswing in the
number of requests being received from regional office staff to conduct
this type of training. During Fiscal 2006 and the first part of Fiscal
2007, the following training has been conducted and/or scheduled:
------------------------------------------------------------------------
------------------------------------------------------------------------
July 2006.............................. Decision Tree for Rating Knee
Disabilities
(New Orleans, Little Rock,
Jackson, Atlanta, Montgomery,
St. Petersburg, Nashville and
San Juan)
July 2006.............................. Local Reasons for Remand Trends
(Louisville)
August 2006............................ New and Material Evidence, Kent
VCAA Notice, and CUE
(Hartford)
September 2006......................... Evaluating Back Disabilities
(New Orleans, Little Rock,
Jackson, Atlanta, Montgomery,
St. Pete and San Juan)
(Nashville--training materials
only)
September 2006......................... Medical Examinations and
Opinions; Rating Knee
Disabilities
(Louisville)
October 2006........................... Adjudicating Nehmer Claims
(New Orleans, Jackson, St.
Pete, Montgomery, Atlanta, and
San Juan)
(Jackson and Nashville--
training materials only)
October 2006........................... Earlier Effective Dates
(Houston)
November 2006.......................... VCAA Duty to Notify; Duty to
Assist--Obtaining Medical and
Service Records; Due Process
Issues; Requesting VA
Examinations
(San Diego)
December 2006.......................... Questions & Answers
(Boise)
December 2006.......................... Evaluating Evidence
(Louisville)
January 2007........................... VA Medical Examinations and
Opinions
(St. Pete, New Orleans, San
Juan, Montgomery, and Atlanta)
(Nashville--training materials
only)
January 2007........................... Special Monthly Compensation;
Competency and Credibility of
Lay Statements; VCAA Duty to
Notify; Local Reasons for
Remand Trends; VA Medical
Examinations
(Salt Lake City)
February 2007.......................... VA Medical Examinations and
Opinions
(Little Rock)
February 2007.......................... Earlier Effective Dates; VA
Medical Examinations and
Opinions; Secondary Service
Connection Claims, Including
for Alcohol Abuse; Service
Connection for ``Tension
Type'' Headaches; Benefit of
the Doubt/Reasonable Doubt
Standard
(Phoenix)
March 2007............................. VA Medical Examinations and
Opinions
(Jackson--awaiting delivery of
new equipment)
March 2007............................. Rating Skin Disorders;
Periodontal Disease; Claims
for Service Connection Based
on Aggravation; Adjudicating
New and Material Evidence
Claims; Weighing Non-medical
Evidence When Rating Mental
and Musculoskeletal Disorders;
VA Medical Examinations and
Opinions; Duty to Assist/
Additional Records Requests
(Ft. Harrison)
April/May 2007......................... Weighing and Evaluating
Evidence
(New Orleans, Little Rock,
Jackson, Atlanta, Montgomery,
St. Pete, Nashville and San
Juan)
------------------------------------------------------------------------
Finally, besides the training that is provided during travel board
trips and by way of videoconference, the Board regularly responds to
informal requests received from regional office staff for our views and
suggestions on a wide variety of case-related legal and medical issues.
______
Response to Written Questions Submitted by Hon. Larry E. Craig
to Hon. James P. Terry, Chairman, Board of Veterans' Appeals
Question 1. In recent years, thousands of claims were filed that
all sought the same relief -- dual ratings for bilateral ringing in the
ears. It is my understanding that, while the courts tried to resolve
the underlying legal issue, these cases were essentially proceeding
separately up and down the system, creating workload spikes at all
levels of the process.
Question 1(a). What impact did this have at the Department of
Veterans Affairs (VA) regional offices and at the Board of Veterans'
Appeals?
Response. These claims for an increased rating, in excess of 10
percent, for ringing in the ears (tinnitus) were processed by the
regional offices in the same manner as any other claims. Under VA's
interpretation of the law, our regulations do not provide for a
schedular evaluation for ringing in the ears in excess of 10 percent,
whether the ringing is perceived to be unilateral, in either ear or in
both ears. As a consequence, the claims were denied at the regional
office level, and then many were appealed to the Board.
When these claims were appealed, they were considered by the Board
in docket order, with the exception of those appeals that were advanced
on the docket because of serious illness, severe financial hardship, or
other good cause, such as advanced age. They were adjudicated in
accordance with VA regulations, which provide for a single 10 percent
rating for tinnitus, and accordingly the appeals seeking increased
ratings were denied.
Some of these decisions were then appealed to the CAVC. The Court
invalidated the Secretary's interpretation of VA regulations and
concluded that a rating in excess of 10 percent was assignable for
tinnitus perceived as ``bilateral.'' Smith v. Nicholson, 19 Vet. App.
63 (2005), rev'd, 451 F.3d 1344 (Fed. Cir. 2006). At that point, a
Department-wide stay was imposed on all cases affected by the Court's
decision while the Secretary appealed the Smith decision to the U.S.
Court of Appeals for the Federal Circuit (Federal Circuit).
The Department's authority to impose such a stay was challenged by
a petition for a writ of mandamus filed at the CAVC. While the CAVC
subsequently concluded that the Secretary does not have unilateral
authority to stay cases at the Board pending an appeal to the Federal
Circuit of a decision issued by the CAVC, the CAVC denied the
petitioner's request for a writ. Ramsey v. Nicholson, 20 Vet. App. 16
(2006).
On appeal of Smith, the Federal Circuit reversed the CAVC's
decision. In pertinent part, the Federal Circuit upheld the Secretary's
interpretation of VA regulations providing for a single 10 percent
rating for tinnitus. The Departmental stay was then lifted and all
affected cases were promptly adjudicated. The Board decided over 4,000
of the appeals that had been subject to the Smith stay in a period of
less than 2 months.
Question 1(b). If similar claims were either consolidated or stayed
early in the process, what do you believe would be the result?
Response. The consolidation and/or staying of cases involving a
common unresolved legal issue at the CAVC, and staying of cases at the
Board and regional offices, would help ensure that similarly situated
veterans, such as those with bilateral tinnitus rating claims, are
treated in a consistent manner. Doing so also prevents the Board's or
the Court's docket from being flooded with cases that may require
additional follow-up review depending on the ultimate decision made on
the common legal issue.
One of the challenges posed in consolidating or staying cases,
however, is first properly identifying them as falling within the
parameters of the consolidation/stay. At the Board, for example, cases
were not placed in the Department's Smith stay until their individual
places on the Board's docket were reached and the cases were reviewed
by VLJs and attorney staff. Interestingly, while the Court found in
Ramsey that the Board did not have the authority to stay cases, the
Court itself imposed a stay on processing of bilateral tinnitus cases
on the Court's docket once the Federal Circuit overturned the CAVC's
decision in Smith and an appeal petition was filed by the appellant
with the U.S. Supreme Court.
Recently, in Ribaudo v. Nicholson, 20 Vet. App. 552 (2007) (en
banc), the CAVC rejected the Secretary's argument that he possesses the
inherent management power to stay cases pending before the Board that
are potentially affected by a precedential decision of the Court, and
more specifically, Haas v. Nicholson, 20 Vet. App. 257 (2006). Instead,
the Court stated that if the Secretary or Board wishes to stay the
effect of Haas, the Secretary must file with the Court, or the Federal
Circuit, a motion to stay the precedential effect of the Court's
decision. The Court set forth detailed procedures for the Secretary to
follow should he desire to have a Court decision stayed. The Secretary
subsequently complied with the Court's request and in January 2007
filed an opposed motion with the CAVC requesting, in particular, that
the Court stay the precedential effect of Haas pending judicial
resolution in Haas. On April 13, 2007, the Court granted the
Secretary's motion to stay in part. Ribaudo v. Nicholson, No. 06-2762
(U.S. Vet. App. Apr. 13, 2007) (en banc). Specifically, the Court
ordered that the adjudication of cases before the Board and VA regional
offices that are potentially affected by Haas is stayed until mandate
issues in the pending appeal of Haas to the Federal Circuit. The Court
did indicate, however, that the Secretary may consider motions for
advancement on the Board's docket in cases to which Haas will apply.
Question 2. I was very pleased to learn that, in addition to
providing expedited decisions to severely injured veterans of Operation
Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), VA is now
providing priority claims processing for all OIF/OEF veterans.
Question 2(a). Does VA have performance goals in place for those
veterans' claims for the VA regional offices and the Board of Veterans'
Appeals?
Response. The Board has performance standards in place for all its
VLJs and staff counsel. These standards apply to the work they perform
on all appeals considered, without regard to the particular period of
service of the veteran. These standards stress the quality, timeliness
and productivity of decisions.
Question 2(b). Would you please provide the Committee with an
update on how many of these claims VA has received since these policies
were instituted; how many of those claims have been decided and the
average time it took to render those decisions; how many are still
pending and how long on average they have been pending; how many of
these claims have been granted and how many have been denied; what
percentage have been awarded service connection with disability ratings
in excess of 10 percent; what are the nature of the claimed
disabilities and the disabilities for which service connection was
granted; and what is the accuracy rate for decisions on these claims?
If this information is not available due to data limitations, please
provide the Committee with a time frame within which that information
will be available and can be provided to the Committee.
Response. VA receives a data file from DOD identifying veterans who
were deployed in support of GWOT. We match this data file with data
from VA's information systems to track health care and benefits usage
by GWOT veterans.
The most recent update from DOD includes veterans discharged
through November 2006. This data file was compared to VA records
through February 2007. This match identified 181,966 GWOT veterans who
have filed a claim for disability benefits either prior to or following
their GWOT deployment (approximately 26 percent of 689,317 total GWOT
veterans).
Many GWOT veterans had earlier periods of service, and they filed
for and received VA disability benefits before their most recent
deployment. VBA's computer systems do not contain any data that would
allow us to attribute veterans' disabilities to a specific period of
service or deployment.
Of the 181,966 GWOT veterans who have filed a claim either prior to
or following their GWOT deployment, 136,189 were awarded service-
connected disability compensation, 17,241 were denied, and 28,536 have
claims pending. Among those awarded service-connected disability
compensation, 83,676 (61 percent) received a combined degree of
disability rating greater than 10 percent.
The charts that follow provide a breakdown of those awarded
service-connected disability by combined degree of disability and the
most frequently claimed service-connected disabilities.
GWOT Veterans Awarded Service Connection by Combined Degree of Disability
----------------------------------------------------------------------------------------------------------------
Combined Degree (in percent) Reserve Guard Active Duty Total
----------------------------------------------------------------------------------------------------------------
0......................................................... 10,551 11,380 21,931
10........................................................ 12,763 17,819 30,582
20........................................................ 6,738 13,343 20,081
30........................................................ 5,060 13,202 18,262
40........................................................ 4,195 11,290 15,485
50........................................................ 2,155 6,430 8,585
60........................................................ 2,241 6,548 8,789
70........................................................ 1,348 3,952 5,300
80........................................................ 965 2,528 3,493
90........................................................ 404 1,039 1,443
100....................................................... 719 1,519 2,238
-----------------------------------------------------
Total................................................. 47,139 89,050 136,189
----------------------------------------------------------------------------------------------------------------
Ten Most Frequent Service-Connected Disabilities for GWOT Veterans
[Both Active Duty and Reserve/Guard]
------------------------------------------------------------------------
Diagnostic Code Diagnosis Description Count
------------------------------------------------------------------------
6260.............................. Tinnitus................. 39,120
5237.............................. Lumbosacral or cervical 33,904
strain.
6100.............................. Defective hearing........ 28,589
5299.............................. Generalized, Elbow and 22,813
Forearm, Wrist, Multiple
Fingers, Hip and Thigh,
Knee and Leg, Ankle,
Foot, Spine, Skull,
Ribs, Coccyx.
9411.............................. Post-Traumatic Stress 17,644
Disorder.
5271.............................. Limited motion of the 16,907
ankle.
5260.............................. Limitation of flexion of 16,556
leg.
5242.............................. Degenerative arthritis of 12,834
the spine.
5201.............................. Limitation of motion of 12,127
arm.
7101.............................. Hypertensive vascular 12,084
disease (essential
arterial hypertension).
------------------------------------------------------------------------
We are unable to provide an accuracy rate specific to claims
received from veterans deployed in support of GWOT. VBA's quality
review program includes a random sampling across all claims filed for
compensation and pension, including those submitted by veterans of this
cohort. However, we do not isolate accuracy for any particular sub-
group of the veteran population. We also do not yet have a means of
separately track and measure timeliness of processing for GWOT claims.
A reporting system is being developed to track these claims.
Question 3. In 2005, the GAO reported that there are ``large
performance variations'' among the regional offices. For the lowest
performing offices, would you please provide a comparison of their
performance outcomes to the national performance outcomes over the past
5 years?
Response. We are providing the data requested for the 10 regional
offices currently experiencing the longest claims processing times. VBA
has taken measures to assist with the processing of veterans claims at
each of the listed facilities. For example:
The New Orleans Regional Office (RO) was severely impacted
by Hurricane Katrina. We have temporarily transferred (``brokered'')
work from this facility to other ROs with the capacity to process
additional work to minimize the impact on veterans within that
jurisdiction.
The Pittsburgh RO was recently assigned jurisdiction of
the overseas foreign workload. The processing of foreign claims takes
considerably longer, as it involves working with foreign embassies to
obtain medical examinations and other evidence. During the same period,
the RO lost a significant number of its most experienced personnel
through retirements.
The Chicago RO received an increase in incoming claims as
a result of the special Six State Outreach Initiative. We have
authorized the Chicago RO to hire additional claims processors and have
brokered work to other regional offices to better serve veterans in
this area.
To better serve the veterans residing in the Washington,
DC area, the Roanoke RO recently assumed jurisdiction for the majority
of claims previously assigned to the Washington RO.
To improve benefits delivery to veterans served by the Los
Angeles RO, jurisdiction of claims from veterans residing in Orange
County, CA, was reassigned to San Diego.
----------------------------------------------------------------------------------------------------------------
February
Average Days to Complete 2002 2003 2004 2005 2006 2007
----------------------------------------------------------------------------------------------------------------
Nation............................ 223.4 181.5 165.5 166.8 177.1 177.4
Washington........................ 377.2 266.3 159.4 195.6 251.2 306.3
Pittsburgh........................ 147.2 112.1 167.6 186.5 219.7 260.3
New York.......................... 273.6 230.0 207.4 188.8 229.6 258.4
New Orleans....................... 166.9 150.3 156.5 153.8 269.4 249.3
Anchorage......................... 287.9 232.3 187.4 190.7 241.8 247.3
Des Moines........................ 223.0 217.7 191.4 209.5 221.4 245.5
Reno.............................. 329.6 261.8 197.6 187.6 203.9 239.9
Chicago........................... 190.6 133.4 185.6 203.7 226.5 237.9
Newark............................ 309.5 276.3 200.9 179.2 232.7 230.8
Los Angeles....................... 239.6 217.4 206.3 211.6 237.4 226.5
----------------------------------------------------------------------------------------------------------------
Chairman Akaka. Thank you very much, Mr. Terry.
I would like to now ask the Ranking Member, Senator Craig,
for his statement.
STATEMENT OF HON. LARRY E. CRAIG, RANKING MEMBER, U.S. SENATOR
FROM IDAHO
Senator Craig. Well, Mr. Chairman, first of all, let me
apologize for being late, but especially to thank you for
continuing to pursue the issue of claims processing on a timely
basis and the appeals process. I know of nothing more important
for the men and women who have served their country in the
Armed Forces than to get a swift and properly designated
decision as it relates to their disability resulting from their
service. This is particularly important, I think, during a time
of war when we have thousands of troops in Operation Iraqi
Freedom and Operation Enduring Freedom separating from service
each year, Mr. Chairman.
Every disability claim is extremely important; however, as
I have previously stated, I believe that during a time of war,
our focus must be on the needs of those returning veterans who
for the first time are applying for their disability benefits.
That is why I asked the VA at several hearings over the last
Congress whether disability claims for those veterans were
being processed by VA on a priority basis.
At that time, VA was already providing expedited decisions
for OIF and OEF veterans who became severely disabled during
service. But as we all know, some disabilities such as symptoms
of traumatic brain injury and mental health problems may not
manifest until months after leaving service. So as you all will
hear today and are hearing, VA is now giving priority to
disability claims from all OIF and OEF veterans regardless of
when their claim is filed. I think this is a significant
improvement, and I commend Secretary Nicholson for instituting
the policy.
That said, I think it is clear to everyone here that the
system overall is struggling and that some veterans are waiting
far too long for decisions. In recent years, VA has taken a
number of measures to try to improve this situation by
consolidating certain types of work, creating special teams,
streamlining work processes, and instituting new training
policies. We have heard about some of that in just the last few
minutes. There also has been a significant focus on hiring
additional staff. In fact, as you can see, I think, by the
chart behind me, the size of the claims processing staff has
been trending upward over the past 10 years. With the
additional employees that Mr. Terry just mentioned, staffing
will have increased from 1997 to 2008, if we can bring that
budget on, by about 61 percent. Also during that period,
funding for the Compensation and Pension Service will have
increased 118 percent.
[Fiscal Year 1997 to Fiscal Year 2008 Compensation and
Pension Staffing chart follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Despite those dramatic increases in staffing and funding
and VA's other efforts to improve performance, the number of
pending cases has been rising and timeliness has been
deteriorating. Although I hope that further increases in staff
will help turn things around, I do not believe that simply
adding employees is a long-term solution to our problem.
For many years experts have stressed that significant
improvement may not be possible without fundamental changes,
and that is to the design and the operation of the system
itself. In fact, in 1996, the Veterans' Claims Adjudication
Commission concluded that ``the problems with the existing
system are so many and varied that it cannot be fine-tuned into
a system that will consistently produce timely and high-quality
adjudicative products.''
After years of struggling to improve the performance of the
existing system, it may be time to acknowledge that those
experts are correct, that we need to make fundamental changes
to the system before we will ever see true, lasting
improvement.
In that regard, as you can see by another chart behind me,
Mr. Chairman, a number of specific reforms have been suggested
over the years, such as closing evidentiary records during the
appeals process, offering lump-sum payments to veterans with
minimal disability conditions, updating the disability rating
schedule, or removing redundant procedural requirements.
[Options for Fundamental Reform chart follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
It has also been suggested that VA could improve
productivity and consistency by consolidating claims processing
into fewer than 57 offices. Over the years, some offices have
chronically underperformed, while others have routinely met or
exceeded expectations. If veterans would receive better service
by shifting claims processing to a higher performing office,
that seems to be an option well worth considering. But whether
it is that recommendation or others, I hope the Committee will
take a very serious look, Mr. Chairman, at what options we have
not tried. It seems that some believe the solution to every
problem in VA is just more staff. I think we ought to look at
the way we do it, the techniques, the style, the inconsistency.
Our colleague from Illinois, who is on this Committee,
talked about decisionmaking in that office that was
inconsistent as it relates to claims payments in other offices
across the country. It is that kind of inconsistency that I
think is frustrating us all. It is not to suggest that people
are not working hard in most instances. But if the system is
not throughputting in the way that we would expect it to be for
the sake of the veteran, then I think we need to take a more
serious look at it than just throwing money at the problem. We
need to look at the fundamental system and how it works, or, as
others have recommended over a period of several decades,
fundamental changes are necessary.
Thank you very much, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Craig. I know
you have been very passionate about this, and while you were
Chairman you had, as you pointed out, several hearings on this
subject.
May I now call on Senator Rockefeller for any statement he
may have.
STATEMENT OF HON. JOHN D. ROCKEFELLER IV,
U.S. SENATOR FROM WEST VIRGINIA
Senator Rockefeller. Thank you, Chairman Akaka and Ranking
Member Craig.
This hearing and those many hearings which are going to
follow not only on this Hill but all across the country are
going to be critical, because if you go back to the Vietnam
War, you will remember it was really not until Admiral
Zumwalt's son got and died from cancer that all of us came to
really understand what Agent Orange was and fund compensation
for those suffering from it.
If you go back to the Gulf War I, there are those who
disagree--but I am not one of them. I think pyridostigmine
bromide was a major factor in the illness that tens and tens of
thousands of people across this country, many of whom live in
my State and whom I visited and spent a lot of time with and
who are completely disabled, that was a factor. Still to this
day such veterans are shunted aside by the DOD and, I would
have to say, by you simply because we are all working for the
same purpose.
And now we come to today. I just want to read a portion of
a letter from a West Virginian returning from Iraq, and he
said, ``When I contacted the VA office by phone, I was advised
they are running behind and I would not be receiving my first
disability payment for 6 to 8 months. My question is: How am I
supposed to survive until I start my disability pay? I have
rent. I have a truck payment, utilities, food, child support to
pay. Will I be evicted from my apartment and have to live in my
truck until it is repossessed.''
Now, that person spent 6 to 8 months in Iraq, and in
closing, I just think there are so many issues--PTSD, traumatic
brain injury, mental health problems--which have been talked
about for years. I can remember that the conference committee
of the veterans conference, in 1997, I believe, passed a long-
term care policy for outpatient services. I do not think it has
been particularly implemented. My dissatisfaction is not just
with this chart, which is stunning, but with the degree of
response and the particular kind of isolation that comes when
you have 220,000, 250,000 employees and then you have them
working in rooms without windows, many of whom never get out to
see the people that they are serving because they cannot, jobs
do not allow for that. It is sort of emblematic of Government
not serving, not understanding, not knowing the people of
America. And that is distressing, and I am glad, Mr. Chairman,
that you and the Vice Chairman are having these hearings.
Chairman Akaka. Thank you very much, Senator Rockefeller. I
understand that you have other responsibilities this morning,
and for that reason, I would permit you to ask any questions
that you may have at this time before I call on other Members.
Senator Rockefeller. I could not possibly ask a question
before Jon Tester and Jim Webb made statements.
Chairman Akaka. All right. We will ask----
Senator Rockefeller. I am physically incapable of doing
that.
[Laughter.]
Chairman Akaka. I will ask Senator Tester.
STATEMENT OF HON. JON TESTER
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman.
Senator Rockefeller, I am not sure that my presence or
Senator Webb's presence would stop you from asking questions,
but we will take that as compliment. Thank you very much.
I am not going to take a lot of time right now because I do
want to ask some questions later down the line. But I can just
tell you this, folks, something to think about while you are
sitting there: (1) I appreciate the job you do; and (2), when I
go out in the field in the State of Montana and visit with
veterans--and I have visited with a lot of them over the last
couple of years--there is an issue about access. It is a real
issue.
Now, in Montana, I will tell you that I have been through a
lot of the veterans homes, and I have been through the facility
there at Fort Harrison, and I can tell you that unlike what we
see at Walter Reed, this is a top-flight facility and the
doctors and nurses there do a tremendous amount of good work.
But also in that case, we are burning them out. There is not
enough of them. There needs to be more of them to provide the
kinds of services that our veterans need in the State of
Montana. And my guess is that may be symptomatic throughout the
United States.
I have a concern with the budget that the President put
forth. I do not think it is adequate. I do not think it is
visionary at all as we look at what the potential impacts of
the veterans coming back from Afghanistan and Iraq are and the
kinds of impacts that they are going to have on the system.
But as for right now, I can just tell you this, Mr.
Chairman, Members of this Committee, everywhere I go in
Montana, every veterans group I visit within Montana talks
about access and talks about delays and talks about the
inability to get in and get their treatment, to the point--and
I am looking at some of the documents here that talk about a
111-day average. That is not what I am hearing in the field. I
am hearing ``years.'' And that is not acceptable. In some
cases, 111 days is not acceptable, but it is a heck of a lot
better than years. But ultimately, in the end, what I hope to
have accomplished from this hearing is that we really do get
the kinds of benefits for veterans that they deserve across the
board for all of them, the ones inside the system and the ones
that are trying to get into it.
So thank you very much, Mr. Chairman.
Chairman Akaka. Thank you.
Senator Jim Webb?
STATEMENT OF HON. JIM WEBB,
U.S. SENATOR FROM VIRGINIA
Senator Webb. Thank you, Mr. Chairman. I just would say
very briefly at the outset that having participated in the
Armed Services Committee hearing yesterday, as did you, with
respect to what I think a number of us are beginning to realize
is kind of a systemic breakdown in the transition of people
from active duty into the veterans community, I am really
grateful that you and Chairman Levin are going to continue to
look at that through joint hearings. I think that is probably
the key issue on the table here. It affects how people are
being processed out of active duty, not only on the medical
side, but on a wide variety of areas. It affects priority of
leadership, where we are putting our money, where we are
putting our energy. And it also, I am sure, manifests itself in
the workload that you are receiving over here in the Department
of Veterans Affairs.
I have some questions that I want to ask at the appropriate
time, particularly with respect to whether there are some
specific ways to address the nature of this backlog, other than
simply the volume of it. I will refrain from asking those
questions at this time, and I appreciate being a part of the
hearing.
Chairman Akaka. Thank you very much, Senator Webb.
We will now go into the questioning period, and as I tried
to do, I am going to ask Senator Rockefeller to begin with his
questions. Senator Rockefeller?
Senator Rockefeller. Thank you, Mr. Chairman. I will just
pose a couple--no ``just'' in front of that. I will pose a
couple.
I do not know whom to address this to, and I do not have
time to have everybody answer it. So you will have to make that
judgment.
What is the VA doing to ensure that it can address the
influx of claims that are resulting from the war without
increasing the already unacceptable waiting times? That's
question number one.
You estimate that the number of claims will essentially
flatline in the future. I do not understand how that can be
possible, not only in terms of the so-called escalation, or
whatever, in Baghdad. Do you or do you not have a plan for the
surge in claims and cases that will obviously follow from that?
Mr. Cooper. Senator, let me first address what we are doing
for the veterans coming back right now to expedite their
claims. The Secretary has directed and we are, in fact, moving
to make the people coming back from the Global War on Terror
the priority. As a result, any claim we get that is from such a
person, we will make it the priority; we will identify it as
such at the regional office.
About a month or two ago, we started working with OSD on
getting a definitive list of names of people who are considered
GWOT veterans. As we get names, we compare them with all the
claims that have come in and specifically pull out those claims
that have to do with GWOT veterans who have filed claims and we
prioritize those.
In each regional office we have designated several people
to specifically address that group. We have also set up what we
call a Tiger Team at five resource centers, which will work
claims for those regional offices that are overburdened.
So that is what we are doing that is different than we have
done before----
Senator Rockefeller. Could I ask within that question, is
there a possibility--or does it already exist--of simply having
DOD which would keep obviously the battlefield injury records,
simply transfer them by computer directly to you so that they
are immediately available to you?
Mr. Cooper. Senator, I do not think they have that
capability. We get the names, but the medical information we
need comes to us, as it has for all these years, in paper
files. Trying to get those is indeed a problem that we have. We
are trying to set up a program whereby we get that information
early for those people who are filing for disabilities so they
will have their medical record as they get out of the service.
And that is----
Senator Rockefeller. That is Gulf War I all over again.
Mr. Cooper. What I am saying is that information is not
available to us directly from OSD.
Senator Rockefeller. Has there been any discussion you know
of--there are a lot of computers in the battlefield. That was
not the case 10 years ago, 15 years ago. Has there been any
discussion of that? I cannot think of anything that strikes me
as more sensible than being able to transfer information. Now,
in this case of pyridostigmine bromide, a lot of soldiers would
take it for a couple of days. They would start getting sick.
They would stop taking it. So the recordkeeping was bad. But
when you have injuries and clear medical histories and that has
to be written down by hand as opposed to the hundreds of
thousands of computers that are on the battlefield and in the
hospitals in Germany and elsewhere, it would strike me as
something which is either eminent or imminent.
Mr. Cooper. In this case it is not.
Senator Rockefeller. Why?
Mr. Cooper. I cannot answer that question.
Senator Rockefeller. Has anybody discuss that?
Mr. Cooper. Oh, yes. There is ongoing discussion because of
the medical records that we have in VHA that are electronic. I
do not want to throw any stones, but the fact is that the
medical records that we get to adjudicate a claim are paper. We
get files.
Senator Rockefeller. Your records are, in fact, the best in
the health care system in this country. That is what I
understand.
Mr. Cooper. Yes, sir.
Senator Rockefeller. So what is it possible for you to do
to create enough ill will and pressure to try to get the DOD to
do something which is reasonably similar?
Mr. Cooper. I would say to you that there is a Joint
Executive Committee which meets every 3 to 6 months, and there
are two ancillary Committees: one is Health, which does address
that part of it. (Of course, on the Benefits side, we have a
Subcommittee on Benefits.) It is discussed, and I do know that
there are plans that OSD is working on to get into the modern
era with records. But they certainly are not there now.
Senator Rockefeller. Thank you, sir.
Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Rockefeller.
And now we turn to Senator Craig for his questions.
Senator Craig. Mr. Chairman, Senator Rockefeller has
touched on something that I think has been frustrating to us
and to VA for a long while, and I do not know what it takes to
turn a battleship around, other than to hit it with a torpedo,
maybe. But, Senator Rockefeller, we had DOD records accessible
to the VA medical facility in Richmond so that for these
traumatically injured--we could look at their records. Then we
had a decision made by an attorney who said, ``Well, you should
not be doing that. There may be some liability here,'' and it
was stopped. And we intervened, and it got started again.
Also we have a new naval facility up in Illinois where the
Navy and VA and the hospital are working side by side now so
the new incoming Navy men and women will have a joint record,
and it will be Navy/VA.
Here we have a modern military and still have no ability to
transfer records. It is just mind-boggling to me, and Dan has
talked about it. It still comes in a paper file. We are proud
at VA that we are the most sophisticated medical recordkeeping
health care delivery system in the country, but we have to re-
create medical records from paper to digital coming from the
most modern military system in the world.
Senator Rockefeller. At the same time as we have VA
hospitals and DOD hospitals increasing in their collaboration.
Senator Craig. Yes. So, I mean, it is a very slow start,
but it is a very inconsistent start, and, therefore, it is
phenomenally frustrating to those of us who have tried to nudge
this along. To talk seamless transition and not have immediate
record transition, electronic record transition, is, in fact,
not seamless.
As I said, we are nudging it along. It is starting. But as
I say, I do not know how you awaken DOD to the modern reality
of electronics.
I hope I am expressing my frustration to the Committee that
we have been working at this for some time and getting nowhere.
Senator Rockefeller. Again, with the forbearance of
Senators Tester and Webb, I would simply add this. When one
comes into an office where there are piles of records, paper
records all over the place, all motivation, all psychological
motivation for I have got to get this one first, that one
second, and I have got to get it done, I have got to drive and
motivation disappears. I think that is in the nature of human
beings. People go down the list, go down the pile, but the
urgency and obviously the timeliness of it completely
disappears.
Senator Craig. Yes. Well, I have taken most of my time. Let
me ask one question because there is progress. VA, as I
mentioned in my opening statement, is moving all of our OIF/OEF
folks to a priority position, but there is still the whole
issue of long-term adjudication and timeliness. And I have
talked about whether you can just keep pushing things through
the same system expecting a timelier response by adding people.
And I guess both to you, Admiral Cooper, and to you, Mr. Terry,
would it make sense to examine and look at the potential to
reduce the number of offices that are processing disability
claims, particularly if that means removing that function from
offices that routinely underperform, and expanding, modernizing
those offices that do perform and demonstrate expertise, and
move ourselves to a higher level of performance as it relates
to these kinds of claims? I understand the sophisticated
character of what we are doing here and the allocation of
resources that ultimately transpires and the importance of that
resource not only to the recipient but the impact of it on
budgets and Government and all of that. So it is a fine thread.
I understand that.
But I do not know of anybody in the private sector that
would tolerate a claims adjudication in the untimeliness that
happens at the Federal level with VA. How do we fix this beyond
just pushing more staff at it? Or is that the answer?
Mr. Cooper. Well, that is certainly predicated on the paper
claims we get. That has to be part of the answer, and we have
asked for an increase in people. But we have been looking at
consolidations. One thing we need to do is to get some of these
more difficult types of claims consolidated. Radiation is a
primary example and we have moved those claims in the last 6
months to Jackson, Mississippi. That way we do not have people
who are doing relatively standard types of claims, although
somewhat complicated, suddenly diverted to doing a a type of
claim that they only did once last year and they have only one
this year and so must go back to the books and relearn how to
adjudicate it. So we did that with radiation. We have done that
with other types of things, like CLL.
What I have tried to say is that there are some difficult
types of claims that can be moved to a given regional office
and, therefore, any of those claims that come in anywhere are
consolidated there.
A second item is----
Senator Craig. So you are suggesting that within these 57
offices, you are developing--your idea is to develop levels of
expertise on certain types of claims, and they go to a certain
office where that expertise rests.
Mr. Cooper. That is one aspect. The other aspect is that
there are several regional offices that are not as productive
as they should be. And so, as you know, one of our processes is
brokering; namely, if one office has too many claims and I have
the capacity in another office to adjudicate those claims, I
will transfer those claims to that office and, therefore, try
to use our entire operation to do these claims. But I agree
with you that we should be able to get into a better
consolidation program whereby we have fairly large regional
offices in specific parts of the country and then other small
offices that are more intake sites. I set up a model for that
with benefits delivery at discharge where, at 140 facilities
around the country, Army, Navy, DOD facilities, we have a group
of two, three, four people who take in claims from young men
and women leaving the service, getting all the information they
can. We have requested they take in all those claims for
disability 60 days ahead of their getting out of the service.
That way we can take advantage of getting the medical exams
that are necessary. We can take advantage of getting their
medical records right there and, having put all that together,
then we have two sites that we send them to for adjudication.
One is Winston-Salem and another one is Salt Lake City.
I see that as a model to work toward where we have intake
sites at various places and then larger regional offices to do
the adjudication.
Another problem I have to look at, however, is what is the
optimal size for a regional office before the workload becomes
so burdensome that it is not run effectively. I am trying to
look at that. As I say, I am trying to use BDD as a model.
So there are two types of consolidation: one is having
larger offices that are good offices and have a good group of
people process claims sent from intake sites; the other type is
taking the harder-to-rate types of claims and have them moved
into one office so we have people that become experts at
working those cases.
Senator Craig. I have taken all the time, and more. Yes or
no: Are the movement of claims between these offices
electronic?
Mr. Cooper. No, sir. You are sending the files. They
absolutely are not electronic and that is one of the problems
we look at very carefully because of security. We work with the
company that has that contract, and we have to make sure that
the files leave properly, are properly tracked, and properly
arrive.
Senator Craig. Thank you, Mr. Chairman.
Chairman Akaka. Thank you, Senator Craig.
Admiral, you mentioned that the Secretary has asked you to
set up a system to prioritize claims submitted by those who
participated in the Global War on Terror.
My concern regarding this priority is the effect of
prioritization on the claims of all other veterans. And my
question to you: Are measures being taken to ensure that all
other veterans with claims in the system are not adversely
affected by the prioritization of Global War on Terror claims?
Mr. Cooper. The answer is yes, sir. On the other hand,
there are only so many priorities and, as a result, I imagine
that other pending claims are going to take a little longer.
However, we have increased overtime.
We also have authority to get retired annuitants to come
back and adjudicate claims for the Tiger Team in Cleveland that
I mentioned. That Tiger Team was set up shortly after I came on
board by Mr. Principi to take care of veterans who are 70 years
old and older and who have had a claim that has been pending
for a year or more.
When we started that process 5 years ago I think we had
about 15,000 claims in the queue. We now have about 2,000. And
we did bring on recently about 24 man-years of retired
annuitants to help us in that respect.
Chairman Akaka. Admiral Cooper, let me ask something that
is somewhat outside of the scope of today's hearing. I would
like to get some preliminary information on the record
regarding the Benefits Delivery at Discharge program.
Mr. Cooper. Yes, sir.
Chairman Akaka. Can you share with the Committee where BDD
is currently active and to what extent it is catering to
military transition facilities, such as Walter Reed, where a
large number of seriously injured servicemembers are being
cared for? Also, can you describe what costs would be
associated with expanding BDD services to reach, again, all
seriously wounded servicemembers and get them into the VA
compensation system upon separation from the armed services,
including the Guard and Reserves?
Mr. Cooper. Yes, sir. Mr. Chairman, there are two separate
questions there. One question is how are we dealing with the
seriously wounded who come into Walter Reed or Bethesda and
eventually get to about eight military facilities around the
country. That is completely separate from Benefits Delivery at
Discharge because we have prioritized these veterans since 3
years ago when Secretary Principi set up what he has called the
``Seamless Transition Program.''
We have people at Walter Reed, at Bethesda, and at the MTFs
who contact the young men or women, the service personnel, and
their families and try to explain, when they are ready to
receive that information, everything that we can tell them
about benefits. Then we try to make sure that, as they leave
Walter Reed or as they leave other MTFs, we have gotten all the
medical information necessary to adjudicate the claim. Our goal
is to have the claims as soon as we receive notice that they
are out of the service, the DD214 in hand, which we have to do
by law. We then adjudicate the claim, and our goal is to have
them receiving pay as soon as possible, about 40 days after
they are out of the service. That is the way we have
consistently been working with these seriously wounded the last
3 years.
Now, once in a while there are some that fall through the
cracks. That is terrible. As soon as I find out about that, we
jump on it and take care of them. But, in general, that is the
way the system operates.
The BDD system, on the other hand, is strictly for those
people who are leaving the service or retiring and we tell them
they can come to us 180 days before they get out, but at least
if they come in 60 days before we should be able to adjudicate
their claims under Benefits Delivery at Discharge. So, shortly
after they are discharged, they will start receiving whatever
disability benefits that they are allowed by the system.
There are also those who, as they get out, do not want to
file for benefits so soon or, for some reason, cannot come to
us at the military facility where we have people. They may come
the week before they leave or a couple of days before they
leave. We then take their claim and send it to the regional
office of jurisdiction where they are going to finally be
located. They have to tell us where they are going to move.
Then we get the records to the regional office that has that
jurisdiction. So, we are talking about two separate programs
here.
Last year, we were able to adjudicate our BDD claims in
about 64 days. That is, if we can get the medical record early.
That is a primary component, getting the medical record the man
or woman has as they leave the service.
Chairman Akaka. I also asked, so it becomes three parts of
that question, and that was the cost of expanding BDD services
and the costs associated with that.
Mr. Cooper. I will take that question for the record. I
cannot tell you the cost. However, let me say that last year we
could have taken in many more claims. The problem is contacting
people, as they are getting close to getting out. We try to
make ourselves available. We make presentations. We reach out
to them. Right now I do not feel it would be effective for us
to have more than those two sites for adjudication and, as I
say, 140 sites at various military facilities to have an intake
for all of those claims.
Chairman Akaka. Thank you. Well, we have a second round.
Senator Tester?
Senator Tester. Mr. Chairman, I just want to make sure I
heard what I heard here a bit ago, and it deals with the forms
you receive from DOD are all paper copies.
Mr. Cooper. Yes, sir.
Senator Tester. Those files.
Mr. Cooper. Yes, sir.
Senator Tester. Has there been any effort to make those
electronic?
Mr. Cooper. This has been discussed, and I think you will
find that on the VHA side or the medical side they have been
talking and I think OSD is moving forward on a program. But
this is still under discussion.
Senator Tester. Because if it revolves around the security
issue, that is not reasonable.
Mr. Cooper. I did not mean to say that. I thought I was
talking on another subject.
Senator Tester. OK.
Mr. Cooper. Once we have these records, we want to broker
them to another place that has the capability to process them.
We have to send these records and they are paper records.
Senator Tester. OK. You know, you have got a lot of smart
people working for you, and I know there are a lot of smart
people in every area of Government--DOD, all down the line. We
are well into the 21st century here, and, quite frankly, being
a farmer, I would probably be the last one to tell you this.
But if it was not for electronic communication, it would be
very difficult to do my job. This is a tremendous impediment
for you, and I know you cannot do it alone, but it would seem
to me that it would help everybody in the system if there was
some sort of standardization in electronic availability of
these records. If you want to address that, that would be
great.
Mr. Terry. Thank you very much, sir. I would like to
address a different aspect of it. While DOD, as the Admiral has
said, is moving, like we are, to an electronic system--and we
hope to have them there before too long. I know when I was in
the Marine Corps, that was a big push by the Marine Corps to
get our records more effectively reproduced in electronic
fashion.
Let me just tell you one concern we have and one of the
things we are working with the court system on. Rule 9, for
example, of the Court of Appeals of Veterans Claims requires at
this time that they have a total paper record before they will
consider an appeal. And the Court of Appeals for the Federal
Circuit requires the same thing in very much a similar rule to
Rule 9 of the Court of Appeals of Veterans Claims.
So those are challenges we are working with those courts to
change as well, and we are working very hard to do that. We
expect that within the next year or two, we will have that
fixed. And that is something that Admiral Cooper and myself and
our staffs have been working with the court to change, because
as long as we have to have this paper record in total form
before they will process that appeal, and if it goes to those
courts--and, of course, each one of our veterans has an
absolute right to do that--we are going to have to maintain
those paper records. And that is one of the things that has
really been holding us up.
But as I say, Senator, we are working very hard to change
that, and we are pushing the court to do that.
Senator Tester. Well, you know, I just think that you are
going to be pulling a plow for a long time until you get this
situation squared away. You know, in 1985, this was probably a
good way of doing it, but we are well beyond that.
I just want to touch on the interface between--for
providing services. You know, as an elected policymaker, I
really depend upon the bureaucracy to really do a good job. I
can appropriate all the money, and I can have all the good
ideas, and if it is not implemented and the money is not spent
right, it does not do one bit of good. And I have got to tell
you, over the last 2 months you deal with a myriad of projects,
and I could go down the list, but it would take all the time.
You know what I am talking about.
This is another one of those projects, and it is a project
for me that really hits home, because we have got a lot of
veterans in the State of Montana, and from a pure principle
standpoint of what is right for this country to be doing, it
makes no sense to me that DOD and VA are not just working hand
in glove to make sure of the transition and make sure the
people get the services they need.
And when we talk about the priority for the veterans now
coming back from Iraq and Afghanistan, I really applaud that.
But I think you also need to know that there are a lot of
veterans out there from the first Gulf War, from Vietnam, and
before--they need help, too. And I would hope that they are not
forgotten about, and I know they will not be.
But the bottom line is this: I really think that I cannot
fix this for you, and if it is a turf war, it needs to be put
aside. But there is a problem here. There really is a problem
here. I hear about it way too much for it just to be some
disgruntled veteran that is not happy. I hear about it
everywhere I go. And my question is: Do you have people within
your staffs that have solutions on how to fix this? Because,
quite frankly, if you do not, we are really in trouble.
Mr. Terry. Senator, I think we do. I think everybody in our
staff, whether it be Admiral Cooper's staff or my organization
or in the Secretary's office, is adamant that we will find
solutions. For example, there is a meeting tomorrow with DOD on
many of these same issues. One of the Committees is meeting,
and that is an ongoing process. People are not hesitating to
come up with good ideas and try to make it work. Sometimes we
have existing regulations that make it more difficult.
For example, in the appeals resolution time that I deal
with every day, we have 330 days of built-in mandatory waiting
times in that process. So before--we have to give 60 days after
receipt of the NOD to offer the DRO process, have to make that
available, have to give them that much time before we can move
on because we do not know what they are going to give us during
that period of time. And there are seven or eight periods like
that that we are dealing with. If we can cut it down to 30
days--and there is no reason we could not, with the kind of
representation. Those are the kinds of things we are
recommending.
Senator Tester. Can that be done administratively or does
that have to be done at this level?
Mr. Terry. Some of it has to be done at your level. Some of
it we can do by regulation. I had a chance to talk to your
staff director a couple of weeks ago, and he had some great
ideas, too. And we are working with your staff, hopefully, to
make some of those kinds of changes.
Senator Tester. I would love to have--and the sooner, the
better--the recommendations you have to help expedite this
process, because then we can really start moving forward, I
think, on getting some things done that really help the people
on the ground.
Mr. Terry. Absolutely, and we agree. While these were well
intentioned, were designed to provide rights at one point, now
they are really slowing down the process on behalf of the
veteran, and we need to fix it. I agree with you.
Senator Tester. I am just guessing, but my guess, part of
that has to do with the paper form. And if it was done
electronically, you could cut a lot of those days out.
Mr. Cooper. Senator, could I ask you a question or make a
statement? I want to make a statement.
Senator Tester. You can ask me a question, too.
Mr. Cooper. I am retired military, and the thing that
strikes me is: Why don't we take an individual that comes into
military service and, from then on, everything that is done,
that information, also comes to the VA, because that individual
is going to be a veteran. It is one individual. Why do we have
to suddenly, OK, now you are no longer military, now you are a
veteran, and now we do this. It seems to me that type of thing
is the type of thing that could help.
Senator Tester. Thank you, and I agree.
Chairman Akaka. Thank you very much, Senator Tester.
Senator Webb, and you will be followed by a statement and
questions from Senator Obama.
Senator Webb. Thank you, Mr. Chairman.
Admiral Cooper and Chairman Terry and others, I would like
to emphasize something that I said in my opening remarks, that
this is the very beginning of an ongoing process, at least in
this Congress, for us to try to address this kind of abyss on
both sides, from moving people out of DOD and hitting the wall
here with the VA and the DVA, and there will be many other
hearings.
I want to say I regret, as soon as I finish my statement, I
am going to have to leave. King Abdullah of Jordan is making a
presentation to a joint session. I would like to hear what he
has to say. But what I would like to do here is to follow up a
little bit actually on what my partner, Senator Tester, was
talking about because I have a lot of the same concerns, and
also to suggest sort of an analytical matrix here, where at
least from my perspective we might move forward.
I, like many people here, have a long institutional memory
with respect to the area of veterans law, and I think as we are
moving forward, we need to tap into that institutional memory
to give us a better understanding of where things are right
now, what is different and what is the same.
We have always had the difficulty, particularly in a period
of wartime, of the VA being able to absorb veterans and treat
them fairly and those sorts of things. And I do not think there
is any group of more well motivated people that I have ever
worked with than people who work in veterans law and the
hospitals and all these areas. I hope we can really do some
honest analysis here about where the breaking points are. We
tend to focus on sort of the issue of the moment or some
legislative piece or those sorts of things. But I think I would
like to start by going back and looking at things like
examining fairly the impetus for this dramatic increase in
claims. Some of that is societal when you look at what has
happened in the breakdown of the medical system, writ large,
and people just wanting to get into some medical system that
will take care of them.
I am wondering, having spent a number of years in veterans
law, and also at a point in my life doing a lot of pro bono
work with veterans, whether actually the standards themselves
have remained the same--the law is pretty much the same--
whether the standards really have remained the same, and
whether the evaluators being trained now understand what the
standards are so that they can move these claims with a note of
certainty about them, not wanting to be second-guessed. You
know, sometimes people are going to be turned down. That is
just the way it is. But when they are, they have to
understand--everybody has to understand--this is done fairly
and these are the standards, they are the historical standards.
At the same time, are the claims more complex now? I am
hearing that people are coming up with seven and eight items on
a claim, so one claim takes longer just by the nature of the
way they are being presented. I am curious also about the
impact of attorney representation, particularly at the claims
level. Is it going to slow it down? Has it slowed it down?
And if you look on the other side of that, I know when I
was doing a lot of work in veterans law, the veterans service
officers were highly trained from the service organizations,
and particularly the DAV, if I may say. They had a tremendous
program, and I know they still do. But is that still the same,
writ large, among the Veterans Service Organizations? And is
the body of people separate from attorneys?
I have strong feelings about the notion of requiring a
veteran to pay. I do not have strong feelings about allowing a
veteran to have a lawyer, but I think requiring a veteran to
pay, particularly on a contingency basis, when some of these
claims are so minute, I just have a problem with that
personally, having helped people and been through the system as
a lawyer helping people at different times in my life.
Those are the kinds of things, I think, we are going to
look at from my staff, and Mike McGarvey, who is working with
us, and who has got a long history of working with the VA.
Those are going to be the starting points for us in terms of
trying to deal with this fairly and trying to find out where
the breaking points are and how we can help move toward a
solution.
And I would make one other comment with respect to what
Senator Tester said about moving from paper to software. We are
going to be taking a hard look at what the Marine Corps is
doing. You know, Chairman Terry, you mentioned the Marine
Corps. And, of course, when you and I were beginning in the
Marine Corps, the Marine Corps was kind of the joke among the
services about not being able to do paperwork and that sort of
thing. Who is going to fill out the unit diary? Who wants to be
an 01, you know? But they have done a marvelous job. From what
we are hearing, they have got a great software program.
I take your point about the certification process, moving
into what you were calling Rule 9. There are ways that we might
be able to move around that, but we are going to be looking at
the Marine Corps system, and perhaps there is something there.
Mr. Chairman, I thank you for the time.
Chairman Akaka. Thank you very much, Senator Webb.
Senator Obama?
STATEMENT OF HON. BARACK OBAMA,
U.S. SENATOR FROM ILLINOIS
Senator Obama. Thank you very much, Mr. Chairman. Thank
you, gentlemen, and I apologize that I did not hear you present
your testimony, but I have had a chance to review some of the
issues. And I just want to pick up on a couple of themes that I
suspect were already discussed, but bear with me if I am being
repetitive.
The first point, just on DOD coordination, can you
reiterate for me, (A) What is being done to integrate VA and
DOD disability review processes more effectively? and (B) What
other steps have been taken by the VA to follow GAO's previous
recommendations that regional offices use an alternative
resource for obtaining military records prior to going through
the inadequate Joint Services Records Research Center? As I
think you are aware, that takes about a year. If you can just
tell me how we are doing on that front and what steps we are
doing to improve it.
Again, this may have already been covered during the
testimony. If it was, I apologize.
Mr. Cooper. No, sir, it has not been.
First, as for the disability process, of course, we have
our own. And, as you have seen in the paper, when a person goes
before the PEB, the Physical Evaluation Board in DOD, nobody
from VA is present. There is no integration in that respect.
And they make whatever decision they make.
Then the veteran comes to us and comes through our
completely separate system. What I can tell you is that, as of
2 days ago, I got a call from people in OSD saying that we need
to get together and talk about this.
The issue of not necessarily merging, but certainly working
together between the military and the VA is something that is
in the embryonic stage and will certainly be pushed. But up
until now, not too much has been done.
The second question that you asked--do you want me to go on
to the second question?
Senator Obama. Yes, please go ahead.
Mr. Cooper. The second question had to do with what we are
doing about medical exams. You spoke of getting medical exams.
There is the record center in St. Louis where we have to go for
records of older veterans, that is, veterans who never filed a
claim but, after 20 years--and this is true with many Vietnam
veterans who are now having effects of Agent Orange--file a
claim. One of the things they must do is to show that whatever
disability they are requesting compensation for has a genesis
to service. If it is Agent Orange related, we must establish
that they were, in fact, in Vietnam, and that sort of thing. We
have to have some kind of proof of that. So many times we have
to get their record because they have retired and the record
has gone to St. Louis to the archives there.
We are now working on a process where we can try to
determine this ourselves to the best of our ability as far as
what--in PTSD, for instance--the stressor is, what happened to
them that might have caused stress and, therefore, caused PTSD.
What we are trying to do now through this program that we
call Benefits Delivery at Discharge is to encourage everybody
who is leaving the service to come see us immediately. We have
140 locations at military sites around the country where they
can come in and bring their record, and, therefore, we have
their record. If they bring it timely (and they can do it up to
180 days before they get out), then we can adjudicate that
claim and have them start getting paid shortly after they leave
the service. It is a benefit to them and to us. It is a benefit
to them because they get the disability payment sooner. It is a
benefit to us because we now have the medical record.
For older claims, we still have to go to St. Louis many
times to retrieve records. For younger veterans, we are trying
to get the records as soon as possible.
Senator Obama. I am running short on time, so let me shift
to the issue of staffing levels. I think it is fair to say that
a number of us on this Committee have been skeptical about some
of the agency's assumptions regarding the anticipated number of
claims in Fiscal Year 2008. You have stated that number at
about 800,000.
Mr. Cooper. Yes, sir.
Senator Obama. Could you discuss in a little more detail
the assumptions the VA has used in reaching this number?
Because we are seeing a 39 percent increase in claims since
2000, a growing number of returned servicemembers from
Operation Iraqi Freedom and Operation Enduring Freedom. On that
count alone, there are some 631,000 discharged servicemembers
who are eligible for some form of care or benefits within the
VA system. Just give me some sense of why it is that you think
there is not going to be substantial growth in this area. And
as you know, we have got a record on this Committee of having
to deal with emergency supplementals mid-year because of poor
planning and anticipation of the needs of our veterans.
Mr. Cooper. Yes, sir.
Senator Obama. So give me some reason why I should feel a
little more assurance that these numbers are solid.
Mr. Cooper. We have a model that we use. The primary
component of the model is the size of the active duty Reserve
and National Guard. Over the last 3 years, our estimates of the
number we expect to get, not counting changes that occur from
the time we put it in the budget until execution of the budget,
our model has been within about 1 percent. The 600,000 or so
that you mention are those who are now veterans coming out. The
number of those who have come to us, including the seriously
wounded and others who have have attained veteran status, is
about 27 percent.
The main point I want to make is that part of the model is
predicated on the number on active duty, assuming a certain
percentage of everybody on active duty will eventually file a
claim. It has been correct within about 1 percent for the last
3 years. I can get some more information on the model and
answer that for the record.
Senator Obama. I would like to get more information on
that.
Mr. Cooper. Yes, sir.
Senator Obama. If you could work with my staff to make sure
that we have that information so that we can follow up on that.
Mr. Chairman, I thank you for the time. I would ask
unanimous consent to place my written statement into the
record.
Chairman Akaka. Without objection, it will be placed in the
record.
[The prepared statement of Senator Obama follows:]
Prepared Statement of Hon. Barack Obama, U.S. Senator from Illinois
Thank you, Chairman Akaka and Senator Craig, for holding this
hearing.
Over the last few weeks, the Nation's attention has refocused on
the moral question of how we are caring for our returning heroes and
their families, from the moment they return from combat, to their
recovery as outpatients, and to their transition and well-being as
honorable veterans. Gut-wrenching revelations of unnecessary red tape
and unacceptable delays compel us to fix and more vigilantly monitor
those agencies and systems that are charged with the sacred duty of
healing our warriors and guiding them through the process of getting
the benefits they deserve.
If the problems at Walter Reed represent the tip of the iceberg--
and sadly, I'm afraid that this is the case--then we are required to
re-examine all aspects of our care system for servicemembers and
veterans. And in this effort, I am deeply grateful to Chairman Akaka
for his leadership on these issues.
Today we hear from the Veterans' Administration (VA) and the Board
of Veterans' Appeals (BVA) on their efforts in reducing the VA's claims
backlog, and the other steps underway to better manage and shorten the
turnaround time for compensation claims and service delivery. I want to
join my other colleagues up front in stating that the President's
budget request for the VA is inadequate, as is the number of new Full-
Time Equivalent (FTE) positions proposed to meet the growing demand of
increasingly complex benefits claims.
I was proud to join Chairman Akaka and other Members of the
Committee in calling for an increase of nearly $2.9 billion in
additional VA funding above the President's request. A portion of this
funding will enable expanded hiring of claims workers so the VBA can
better handle its workload and reduce the backlog. While we want to
find ways to reduce error rates and streamline processes where
possible, we cannot lose sight of the fact that these cases are
increasingly complex and highly variable. Ultimately, the claims review
and adjudication process is a human one, and we need to make sure we
have a sufficient number of highly trained experts to shepherd our
heroes through this process.
Chronic understaffing and underfunding are only part of the
problem. I continue to share the concerns of my colleagues that a lack
of coordination and information sharing between the DOD and the VA
exacerbate the delay in claims decisions, especially in the evidence
gathering phase of the process. I have sponsored legislation, the Lane
Evans Act, which would in part address this problem by requiring the
Department of Defense to provide each discharged servicemember with a
complete electronic file of his or her military records, including
medical information. I hope the Committee will consider this
legislation this year.
Finally, I share the assessment of the Government Accountability
Office (GAO) and our Veterans Service Organizations that we need to
take one step back and look at broader issues that confound the current
claims adjudication process, and how we might ensure the VA has the
resources it needs to get the job done as we welcome a new generation
of veterans home. I look forward to working with Chairman Akaka, the VA
and our other partners in addressing this great national challenge.
Chairman Akaka. Thank you very much, Senator Obama.
I would like to continue with a second round of questions,
and to Admiral Cooper, this is something that goes outside of
the scope of this hearing, but I wanted to ask you for some
information that you can send me.
Mr. Cooper. Yes, sir.
Chairman Akaka. I wanted to tell you about this concern
that I have given the types of injuries that are occurring as a
result of the Global War on Terror.
According to the rating schedule, headaches caused by brain
trauma are limited to a 10 percent rating. However, migraines
can have a rating of up to 50 percent. I think that we need to
be sensitive to the types of injuries that are occurring to our
newly separated servicemembers and make certain that the rating
schedule appropriately reflects the effects of their
disabilities.
Admiral, can you then please send me the rationale for
these differences and the rating schedule and any direction
that has been given to the field regarding rating these
conditions?
Mr. Cooper. Yes, sir. I will have to take that for the
record, and I certainly will.
Chairman Akaka. Thank you.
Mr. Terry, it appears that there is still a gap between the
Board's decisions and the Court of Appeals for Veterans Claims
determinations. Of the 2,135 merit decisions made by the CAVC
in Fiscal Year 2006, only 440 cases were affirmed, while 518
were reversed, vacated, or remanded, and 847 were simply
remanded for further action.
I would like some comment from you on these figures, and do
these numbers concern you?
Mr. Terry. We have a system, sir, which allows information
to flow to the deciding body, whether it be our Board or the
court, in terms of new information concerning certain types of
disabilities in a way that is very, very different than any
other appellate process. And while certainly when you talk
about 518 reversed or remanded, many opportunities exist for
the court to affirm on any number of the issues before it, but
there may be one or two that they send back for additional
information because they are not satisfied in terms of a
remand. So these 518 cases may not all be in any way totally
reversed or require total redress. Many of the issues are
affirmed.
So I think it is important that we understand that this is
a very unusual process where information--the record is never
closed until it gets to the court--and so consequently, you
have to appreciate that these are cases where we are trying to
reach out and provide the benefit to the veteran. From our
perspective, anything the court can do to properly give the
veteran the benefit, we are certainly supportive of. That does
not mean we were wrong with the information we had. Very often
we did precisely the right thing. If the court sees something
that they have, since our decision, ruled in a way that would
change the law, then certainly they ought to give the benefit
of the doubt to the veteran.
One of the things that is interesting, the court oftentimes
is taking a case that we have decided, and it is 2 years down
the road that they are getting to it, or 2\1/2\ years down the
road. And, consequently, if there are changes, if there is a
difference in the manner in which this type of disability is
addressed, either through a change in regulation, certainly
they want to give the veteran the benefit of that. We certainly
do not object to that. We applaud it. I do not think that in
any way denigrates from our use of the existing law at the time
we are deciding the case.
So like I say, like the court, we are trying very hard to
give the benefit of the doubt to the veteran. It is a
nonadversarial process at our level. We consider it to be a
very, very important aspect of their work if they have changed
the way they are looking at any specific disability, to give
that benefit to the veteran.
Chairman Akaka. Thank you, Mr. Terry.
Admiral Cooper, in the President's Fiscal Year 2008 budget
request, $31.6 million is specifically for VETSNET
improvements. What improvements do you think will be made with
this funding?
Mr. Cooper. Let me explain, Mr. Chairman. VETSNET is
something that will get us into at least the 20th-plus century.
VETSNET is a program that was seen as unsuccessful 5 or 6 years
ago, and we have put a lot of effort into making it a success
because VETSNET will give us records that we can then keep
electronically. We have five elements of VETSNET. Three of
those five elements are in full effect, 100 percent, and the
two others, which have to do with actual processing of payment
to the veteran, we are doing very, very carefully because, of
course, we do not want a mistake in the veteran's pay.
We have a specific person that is in charge of this who
answers directly to me. We are also working very closely, and
have for the last 2\1/2\ years, with the CIO. Two years ago we
had a group of contractors come in from Carnegie Mellon, SAI
from Carnegie Mellon, and I asked them to analyze what we were
doing, what we needed to do, and whether we should continue
this program. Their reply was, ``Yes, you should. There are
some things you should do that you have not been doing.''
And we took those steps. I then said, ``Could you help us
in managing this?'' They said, ``No, we do not do that.'' So
then I went back to the CIO, and we brought on board Mitre, and
Mitre has now been onboard for a year.
I think we have made tremendous progress, and, in fact, my
impression is that VA will use the model we have used, the
model for organizing and running this program, in other
programs that they are going to be running centrally. So
VETSNET is very important. This money is to continue us on the
track to be completely using VETSNET at the end of 2008 or
early in 2009. To show you the progress that we have made, as
of the end of February, for all initial claims that came in
this fiscal year, 38 percent of those claims were done
completely in VETSNET. So we are making great strides, and I
think strides that many people thought we would never make.
But, quite frankly, I am quite proud of what we are doing so
far in VETSNET and, although it will not get us into the 21st
century, it will make a major step getting us into a position
to jump into the 21st century.
Chairman Akaka. Well, thank you for that. We will certainly
follow up on that.
Senator Tester?
Senator Tester. Thank you, Mr. Chairman.
Admiral Cooper, if I heard you right to Senator Obama's
questions, you said that you are projecting about 27 percent
will request benefits?
Mr. Cooper. That is approximately right. I just took the
figures that we have right now from the GWOT report where we
can identify those who have come in with claims. OSD identifies
all veterans who participated in the Global War on Terror, and
then we determine how many have filed claims for benefits.
Right now it is about 27 percent.
Senator Tester. OK, because my information shows that in
2006, 69,000 out of 198,000 that went out of the military
requested benefits. That is about 35 percent.
Mr. Cooper. Yes, and I am giving you a figure of all those
who were in GWOT and all those who have left military service.
I am basing it on what DOD told me, and the number I have are
the number of people who actually filed claims.
Senator Tester. All right. Well----
Mr. Cooper. I would be glad to get together with your staff
and make sure we know what----
Senator Tester. That would be good, but the bottom line is
that if you underestimate the projections--and I am not saying
you did, but if they are underestimated, for whatever reasons,
you are never going to be able to be successful, at least
unless you have some abilities that I am not--well, I do not
know about that. OK.
I think, Mr. Terry, you talked about 2,000 folks are in the
queue, and that has been some time ago. That was in the first
round of questions. If a person applies for a benefit and gets
rejected because of some reason--they did not put the right
address down, or I do not know why you reject them, but there
is a rejection because the form is not filled out right. Are
those classified as being in the queue?
Mr. Terry. You are talking about an appeal to our Board?
Senator Tester. I am not actually talking about an appeal.
I am just talking about getting through the door. I am just
saying they have got a problem. They fill out the necessary
paperwork, and for some reason that paperwork is rejected. Is
that classified as being in the queue?
Mr. Cooper. Could I answer the question?
Senator Tester. You sure may.
Mr. Cooper. Because it comes in to me.
Senator Tester. Sure. No problem.
Mr. Cooper. Claims always come in through my outfit.
Senator Tester. Yes.
Mr. Cooper. Eventually, they may get to him.
Senator Tester. OK.
Mr. Cooper. The major change in incoming claims--you saw up
there the numbers that Senator Craig had on the chart.
Senator Tester. Yes.
Mr. Cooper. The major reason for a large increase 5 years
ago in the number of people that we needed, and mostly got, is
something called VCAA. It is the Act which determined exactly
how we should treat claims. Prior to that time, I was not
around, but it appears to me that we were not doing well by
veterans.
Senator Tester. Yes.
Mr. Cooper. So as a result, this Act was passed. It is a
very good Act. It says very specifically that when a veteran
comes in and wants to file a claim, VBA must send a letter to
the veteran that is very specific, detailing all the things
that VBA is going to do and all the things that the veterans
must do. Also, due to a recent court ruling VBA must state the
elements that we will use to decide the claim and how we will
determine the date of claim.
So the law itself is quite specific on what we should do.
Senator Tester. OK, and I understand that. Are those folks
part of the 2,000 then, or are they not? I assume that 2,000 in
the queue means 2,000 that still need additional paperwork to
be accepted into the program to get the necessary treatment
they need.
Mr. Cooper. The number in the queue right now is 400,000.
That is the number in the queue.
Senator Tester. OK.
Mr. Cooper. And they are in various stages of the process.
Senator Tester. So we have got 400,000 folks out there that
are requesting benefits. We do not know for sure if they are
bogus or not, to be honest. But there are 400,000 folks out
there that think they deserve benefits that are not being dealt
with.
Mr. Cooper. That is correct. And last year, we received
805,000.
Senator Tester. So about half of them are being accepted
and half of them are being----
Mr. Cooper. No, not necessarily. No. As a matter of fact,
it really depends on what the veteran is claiming because there
are various rates. If a veteran requests a hearing, you may get
one rate----
Senator Tester. I hear you. I guess the real question is:
Is 400,000 a figure you are comfortable with?
Mr. Cooper. No, sir, not at all.
Senator Tester. What figure would you be comfortable with?
Mr. Cooper. If I want to get to 125 processing days, I
think I would be comfortable with a working level of about
280,000 to 285,000. I think that is about the number that would
give me a working level for processing claims in about 125 to
130 days.
Senator Tester. Do you have recommendations on how to get
to that point?
Mr. Cooper. We are doing many things that hopefully will
get us to that point.
Senator Tester. One last question--if I might, Mr.
Chairman-- because my red light just came on. But the question
I had deals with the stressor event that you were talking about
with an earlier question, and I think you talked about Agent
Orange in regards to Vietnam. The veteran has to go back--and
the files are kept in St. Louis, or are they kept here in D.C.?
Mr. Cooper. Most of them will be kept in St. Louis.
Senator Tester. They have to go back and find out what
event that was where they were exposed to Agent Orange that may
have caused the PTSD?
Mr. Cooper. I was answering a couple of different
questions. In the case of Agent Orange, if you served during a
specific time period in Vietnam, there are several presumptive
conditions that can be considered to have resulted from
exposure--diabetes being the primary one.
Senator Tester. Yes.
Mr. Cooper. If you have diabetes today and you were in
Vietnam during that period----
Senator Tester. Right.
Mr. Cooper.--it is presumed you were exposed to Agent
Orange and, therefore, presumed that you have diabetes as a
result of it.
Senator Tester. If you have PTSD, though, you have to make
a proof that you were exposed?
Mr. Cooper. In the case of PTSD, we must be able to find in
your record something that was a stressor, something that would
cause you to have flashbacks or something that today would
manifest itself as PTSD.
Senator Tester. Is Agent Orange one of those?
Mr. Cooper. I do not think so.
Senator Tester. The real question here is: Vietnam ended in
1973, as I recall. We are dealing with something that happened
to a lot of these folks 40 years ago.
Mr. Cooper. Yes, sir.
Senator Tester. How can they be expected to know when that
happened in order to get that? Do you understand what I am
saying? I mean, if they were, for instance, in a battle at some
point in time, my guess is that most of these folks have been
trying to erase this from their memory for 40 years. How can
they be expected to know? And do they have any help in
accessing those records?
Mr. Cooper. Yes. We try to find out what it was. Besides
going to St. Louis for the records, we also go to an
organization at Fort Belvoir that has unit records. So if we
have the DD214, which says they are now honorably discharged,
we can find out various places where they were or units to
which they were attached.
Senator Tester. Is there--and excuse me, Mr. Chairman. I
guess I could go on all day, so I will just cut this off at
this point. But do you feel you have adequate resources to be
able to help these folks determine when that stressor event
happened?
Mr. Cooper. I feel that, with the resources that we have
requested in 2008, I will be well on the way to having adequate
resources. But it is a long, lengthy process. It is a very
involved process. And that is what----
Senator Tester. I could not agree more. I agree. And that
is why it is important that we not only get the most bang for
the buck but are responsive to the needs. Thank you.
Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Tester.
I want to thank this panel for your responses. As you know,
all of us are working diligently to do the best we can to help
the veterans of our country, and these hearings are conducted
in an effort to do that. Your responses will certainly help us
in doing this, and I hope we can find answers, whether it is
more funds, personnel, or restructuring, to deliver the kinds
of services that our veterans deserve.
So thank you so much for what you are doing, and we wish
you well.
Mr. Terry. Thank you, Mr. Chairman.
Mr. Cooper. Thank you, Mr. Chairman.
Chairman Akaka. I would like to call up the next panel, and
as you approach the desk, I would like to mention your names
and your positions: Daniel Bertoni, Acting Director of
Education, Workforce, and Income Security issues, Government
Accountability Office (GAO); John Rowan, National President,
Vietnam Veterans of America; and Rick Surratt, Deputy National
Legislative Director, Disabled American Veterans.
We welcome all of you to the Committee. Before the start of
this panel, I would like to remind the Vietnam Veterans of
America that although I will allow you to testify before the
Committee today, all testimony must be received by the
testimony deadline. I know from my experience with your
organization that there must be some extenuating circumstances
as to why your testimony was not received by the Committee by
the deadline, but let me just say please make every effort in
the future to get it here on time.
And with that, I would like to ask you make your
statements, and I will call you in the order that I introduced
you. Daniel Bertoni will be first.
STATEMENT OF DANIEL BERTONI, ACTING DIRECTOR,
EDUCATION, WORKFORCE, AND INCOME SECURITY ISSUES, GOVERNMENT
ACCOUNTABILITY OFFICE
Mr. Bertoni. Good morning, Mr. Chairman and Members of the
Committee. I am pleased to be here to discuss the Department of
Veterans Affairs' disability program challenges and
opportunities.
Last year, VA provided nearly $35 billion in disability
benefits to 3.5 million veterans and survivors, and for years
the disability claims process has been the subject of attention
by VA, the Congress, and others due to untimely decisions,
large backlogs, and other weaknesses.
In 2003, we designated VA and other Federal disability
programs high risk because these programs were based on
outmoded concepts and continued to experience management and
operational problems. Since that time, we have issued numerous
reports with recommendations for change.
My testimony today is based on our prior work and focuses
on three areas: service delivery challenges facing VA; actions
taken to improve claims processing; and going forward, areas
where fundamental reform may be needed to significantly improve
performance.
In summary, VA continues to experience service delivery
challenges. While VA has made progress in the past reducing its
claims inventory, it is now losing ground. Since 2003, pending
claims have increased almost 50 percent to nearly 400,000.
Those pending longer than 6 months have also increased more
than 75 percent to about 83,000. The time required to resolve
appeals has also been problematic. The current average
processing time of 657 days is still far from VA's stated goal
of 1 year.
VA also faces challenges ensuring that its decisions are
accurate and consistent. Although the accuracy of decisions is
currently 88 percent, this figure is well short of VA's goal of
98 percent. Ensuring that all veterans receive comparable
entitlement decisions and disability ratings regardless of
location has also been problematic. We have recommended that VA
evaluate all levels of its decisionmaking process to provide a
foundation for addressing decisional inconsistencies.
VA has taken several steps to improve claims processing.
The 2008 budget requests over 450 additional claims processing
staff, a 6 percent increase over last year. Other key
initiatives include increasing overtime, using retired staff as
trainers, and piloting a paperless Benefits Delivery at
Discharge process where servicemember records and other
evidence are captured electronically prior to separation. VA
has also enhanced internal training and information sharing to
reduce the number of cases sent back by the Board of Veterans'
Appeals due to errors or incomplete evidence. And to improve
decisional inconsistency, VA has taken action to develop
baseline data to better monitor and assess decisional
variances.
Despite these efforts, several factors may impede their
efforts. Since Fiscal Year 2000 claims have increased steadily
from 579,000 to over 800,000 last year, placing a substantial
strain on operations. Recent court decisions requiring VA to
assist veterans in developing claims have expanded workloads.
Additional laws and regulations, such as those creating new
presumptions of service-connected disabilities, have added to
the volume of claims. And caseload complexity has also
increased as more veterans claim multiple disabilities, and VA
has had difficulty obtaining all relevant documents. Thus,
continuing to explore new ways to work smarter and more
efficiently, will be essential to VA's productivity.
In going forward, there also may be opportunities for
fundamental reform that could dramatically improve performance.
In designating VA's disability program high risk, we noted that
VA's processes do not reflect the current state of science,
medicine, technology, and the national economy, which has moved
away from manual labor to more service- and knowledge-based
employment.
We also recommended that VA developed a strategy for
periodically updating its disability ratings criteria to better
reflect changes in the economy and job market. We have also
reported that VA's field structure may impede efficient
operations. Despite limited efforts to consolidate some
processes and workloads, VA has not changed its basic structure
for processing claims at its 57 regional offices, which have
experienced large variations in performance and productivity.
While re-examining claims processing challenges can be
daunting, key efforts are underway. In 2003, the Congress
established the Veterans' Disability Benefits Commission to
study many of the issues discussed today, including underlying
program principles, standards for determining disability
compensation, and issues related to how and where cases are
processed. The Commission is scheduled to report to the
Congress by October 2007, and like you, we also look forward to
the report findings.
Mr. Chairman, this concludes my statement. I am happy to
answer any questions that you or other Members of the Committee
may have. Thank you.
[The prepared statement of Mr. Bertoni follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Response to Written Questions Submitted by Hon. Barack Obama to Daniel
Bertoni, Acting Director, Education, Workforce and Income Security,
Government Accountability Office
Question 1. You outlined a number of ongoing challenges that might
confound current VA plans to reduce its backlog and to shorten the
turnaround on the adjudication process.
Beyond staffing and funding levels, what in your view is the most
significant of the challenges you outlined and why?
Response. The most significant of the challenges we outlined is for
VA to keep up with a workload that is growing in volume and complexity.
As we noted in our testimony, the number of rating-related claims VA
received increased by about 39 percent from about 579,000 in Fiscal
Year 2000 to 806,000 in Fiscal Year 2006. While VA expects the volume
of claims to remain at around 800,000 a year in the short term, further
increases in claims filing are possible. This could be the result of
more veterans of the conflicts in Iraq and Afghanistan seeking
benefits, and older veterans filing new and reopened claims. Further,
as recent history has shown, the expansion of benefit entitlements,
such as the addition of new presumptive service connected disabilities,
can significantly increase the number of claims VA receives.
Meanwhile, according to VA, the complexity of claims is increasing.
For example, the number of original disability compensation claims
containing eight or more disabilities increased from about 22,000 in
Fiscal Year 2000 to over 51,000 in Fiscal Year 2006. Because each
disability needs to be evaluated separately, these claims can take
longer to complete.
Question 2. In your testimony, you alluded to more fundamental
reform possibilities within the VA, including a reexamination of its
current regional office claims processing structure.
Could you provide further insight or comment into this idea and
associated tradeoffs, especially from the perspective of a Veteran who
is trying to navigate the claims system?
Response. VBA currently processes claims at 57 regional offices,
which experience large performance variances and questions about
decision consistency. This means that some veterans receive better
service than others based on where they live. Advantages of processing
claims at fewer offices could be faster and more consistent decisions.
VA has already done some consolidations and changes in regional
office jurisdictions to give veterans faster decisions on their claims.
For example:
Processing claims by survivors of servicemembers who died
on active duty at its Philadelphia regional office.
Processing claims from veterans in southern New Jersey at
the Philadelphia regional office instead of the Newark regional office.
Making decisions on Benefits Delivery at Discharge claims
at the Salt Lake City, Utah, and Winston-Salem, North Carolina regional
offices.
In our opinion, to better serve veterans throughout the country VA
needs to undertake a comprehensive review of its field structure for
processing disability compensation and pension claims. Even if VA
consolidated compensation and pension claims processing into fewer
offices veterans could still take advantage of public contact and
outreach services, which would include accepting claims, at offices not
processing claims. Veterans could also file claims by mail and online.
Chairman Akaka. Thank you very much for your statement, Mr.
Bertoni.
Now we will hear from Mr. John Rowan.
STATEMENT OF JOHN ROWAN, NATIONAL PRESIDENT,
VIETNAM VETERANS OF AMERICA
Mr. Rowan. Good morning, Mr. Chairman, and, again, I
apologize that our testimony did not get to the Committee.
Unfortunately, one of our computers decided to blow up.
Chairman Akaka. Well, we are glad to have you here.
Mr. Rowan. Thank you. I am glad to be here.
As one of the people that, unfortunately, started to bump
up the VA's claims processes in the recent years as a service-
connected disabled veteran who originally applied for
disability for diabetes that significantly increased with
various secondary conditions, and have gone through that
process, I understand the process both as a person who has gone
through it as a veteran, and also as a service rep who actually
filed claims on behalf of individuals in the system from 2002
to 2006. After I had retired from my employment for many years,
I took on that as a task.
It was very clear to me, coming out of another Government
sector, that the biggest problem they had, quite honestly, was
this whole paper problem. Listening to the questions and
discussions that have gone on this morning, we can sit here and
talk about the interface between the DOD and the VA, and it
really does not matter. DOD can get as electronic as it can be.
It still ends up in the VA, which creates paper. When the VA
hospital system, which is very good, creates wonderful systems
on the patient they are dealing with and gives a wonderful
trail of the individual's history, they have to print it out
and put it in the paper file. They do not look at it
electronically and then deal with it electronically.
I came out of a public sector company, the Comptroller of
the City of New York, where I reviewed 15,000-page contracts
electronically through my computer system we had, and not only
could I review it, but ten other people could review the same
contract at the same time.
When I went through my training with the VA as a service
rep, I remember going to a wonderful training on something
called the ``Virtual VA'' and how this was all going to work.
And that was a wonderful idea, because, gee, it reminded me of
the program that I had left in 2002 when I retired.
Unfortunately, they were nowhere near doing that.
When I got a new computer for one of my other service reps,
they told us--by the way, I asked them what kind of system do
they need--``we are working on Windows 98.'' And this was in
2004. Something was radically wrong there.
So it is very clear that is the big issue. We have got to
get past that electronic hurdle somehow to deal with all of
these problems that we are talking about. Then you can talk
about interfacing between the VHA, VBA, DOD, and BVA, and all
the rest of it. And that is the real problem.
There are other issues, however, that we can deal with. One
of which is from the VSOs' point of view, as, again, somebody
who handled claims. When we have those claims that are
presumptive disabilities, like the Agent Orange issues, if I
have a doctor certifying that I am a diabetic and I have a
DD214 that shows very clearly I stepped foot in Vietnam, that
case should take about 2 minutes to rate. The problem is it
goes into the same system that everything else goes into and
drags on forever. We need to be able to fast-track what we call
``ready-to-rate claims'' that everybody agrees everything is
done and we are ready to go, and the VA rater should be able to
pick it up, look at it, deal with it, and move it out.
Unfortunately, again, we are talking about getting that piece
of paper moved from one end of the office to the other.
One of the things they talked about taking part in is the
idea of assisting the newer veterans and getting them on a fast
track. We have a little bit of a concern with that. We wonder
if there isn't going to be a little bit of a ``robbing Peter to
pay Paul'' kind of deal here. While the idea of helping the
newer veterans and getting them speeded up is a good idea--and
I really listened to the case that Senator Rockefeller, I think
it was, or Senator Craig maybe--who talked about the veteran
who was coming home and was worried about his claim not getting
adjudicated in time to pay his rent. It is a real issue, and I
take concern about that. But I want to know where they are
going to get all these raters from to deal with these claims.
There is an issue about this idea of putting all the raters
in one spot. One of the problems, at least, again, from my
point of view, working in the regional office, we want to be
able to interface with the people that we are dealing with so
we can get rid of some of the problems that crop up from time
to time on a face-to-face basis.
Anyway, we are here to assist you in the Senate and anybody
else who would like to talk about that, and I am sure my other
colleagues in the other organizations will say the same. And I
appreciate this Senate Committee taking the time to look at
this very serious issue.
Thank you.
Chairman Akaka. Thank you very much, Mr. Rowan. I think you
know that the two Committees on Veterans' Affairs, in the House
and in the Senate, have come together and have reinstated their
meetings with the VSOs. And we are glad to do that and to see
the kinds of responses we are getting from the VSOs on that.
But as you know, what is happening now on the question of
veterans, whether it is benefits or health care, we have
problems and we must get together to help resolve those
problems.
Mr. Surratt?
STATEMENT OF RICK SURRATT, DEPUTY NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS
Mr. Surratt. Good morning, Mr. Chairman. Today's hearing
addresses a major and longstanding challenge for VA: improving
the timeliness and accuracy of the process for deciding
disability benefits claims and appeals. The situation can be
explained simply: The volume of work exceeds VA's output
capacity, and that leads to backlogs. The input of new work
exceeds the output, and the work backs up, with consequent
delays. VA has reacted by pressing for increased production,
compromising quality, and in turn that created more work at the
regional office and appellate levels.
So, if the basic problem is an imbalance between workload
and capacity, why has capacity not increased to match the
workload? The DAV submits that in the politics of the budget
process, VA is not permitted to request the level of resources
it really needs and that Congress too readily accepts VA's
projections that it will improve timeliness and quality with
the resources it requests.
In its budget submission for Fiscal Year 2006, the VA
projected that it could reduce its backlog of rating cases from
321,000 it had on hand in 2005 to 282,000 by the end of Fiscal
Year 2006, with an average processing time of 145 days.
However, the backlog of rating cases had grown to 378,000 by
the end of 2006, and the average processing time was 177 days.
In its Fiscal Year 2008 budget submission, VA projects it
will reduce the 378,000 rating cases in its 2006 year-end
inventory to 369,000 cases in 2007 and 329,000 cases in 2008.
Instead of going in the direction of reducing the backlog to
369,000 cases, the VA has again lost ground. Nearing the
midpoint of the fiscal year, the backlog has grown to 401,000
cases. Yet the budget submission states, ``The 2008 budget
provides resources to timely and accurately process a claims
workload that continues to increase in quantity and
complexity.'' And at the same time the budget submission
acknowledges that the workload continues to increase in
quantity and complexity, it bases VA's resource needs and its
projections for reducing the backlog in 2007 and 2008 on a
decrease in claims receipts for those years.
While resources alone will not solve VA's problems, VA's
problems cannot be solved without the necessary resources. VA's
well-intentioned initiatives cannot succeed if they continue to
be defeated by insufficient resources. Adequate resources are
the essential foundation for rebuilding an effective claims
processing system. We have to stop deceiving ourselves and
admit that these problems are only going to continue and
probably get worse if we do not remedy the root cause. As we in
the DAV have consistently said, quality is the key to
timeliness. Timeliness follows from quality because omissions
in record development, failure to afford due process, and
erroneous decisions require duplicative work, which adds to the
load on an already overburdened system.
Quality is achieved with adequate resources to perform
necessary comprehensive and ongoing training, to devote
sufficient time to each case, and to impose and enforce quality
standards through effective quality assurance methods and
accountability mechanisms. VA has simply not had the resources
necessary to achieve the level of quality required to avoid
unacceptable error rates, increased numbers of appeals, and the
consequent overload that causes backlogs and delays in claims
dispositions.
To achieve optimum quality and claims decisions, VA needs
to have a system and personnel to perform quality reviews on a
sample of decisions from every VA adjudicator. Its current
quality assurance program does not provide information on the
proficiency of adjudicators at the individual level.
To correct the problems throughout, we believe Congress
must invest additional resources primarily at the front end of
the process to reduce the additional work required downstream
and to break the vicious cycle in which the push for quantity
at the expense of quality results in more errors and more
rework, ever more adding to the backlog.
That completes my statement, Mr. Chairman, and I would be
happy to answer any questions that you may have.
[The prepared statement of Mr. Surratt follows:]
Prepared Statement of Rick Surratt, Deputy National
Legislative Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
I am pleased to appear before you on behalf of the Disabled
American Veterans (DAV) to address the necessity and means to improve
timeliness and accuracy in the disability claims adjudication and
appellate processes of the Department of Veterans Affairs (VA).
Achieving timeliness with accuracy has long been a major challenge
for VA, and an ongoing concern of veterans and this Committee. While
increased resources will not alone cure what ills the system, all of
the best efforts to overcome the deficiencies are doomed to fail
without an admission that inadequate resources are at the root of the
problem and without decisive action to correct that cause for
difficulties in timeliness and quality.
Past reductions in staffing levels degraded VA's ability to process
and decide disability claims in a correct and timely manner. After
falling behind, it never fully recovered. With continued growth in the
volume and complexity of claims for disability benefits, VA has not
requested the resources necessary to overcome the existing backlog and
stay abreast of that growth, with a consequent adverse effect upon both
quality and timeliness of claims adjudication. In each of its budget
submissions for recent years, VA has projected improvements but has
fallen short of attaining and maintaining reductions in the backlog and
improvements in quality. The Fiscal Year (FY) 2008 VA budget submission
affords no reason for optimism. VA's actions have not lived up to its
promises.
According to its mission statement for its Compensation and Pension
Service (C&P), the Veterans Benefits Administration (VBA) ``seeks to
provide all possible benefits under the law to eligible claimants in a
timely, accurate, and compassionate manner, and to the extent possible,
apprise potential claimants of possible entitlement to benefits.'' VA
maintains that its 2008 budget provides the resources necessary to
timely and accurately process a claims workload that continues to
increase in quantity and complexity. According to VA, the requested
increase in staffing, new information technology initiatives, quality
assurance programs and controls, and employee training will allow it to
reduce its pending workload, despite factors that add complexity to the
process. However, contrary to its observation that the workload
``continues'' to increase, contrary to the several-year trend of
consistently increasing claims volumes, and contrary to its discussion
elsewhere of factors that would likely continue this trend, VA
projects, without explanation, that it anticipates ``a slight
decrease'' in receipts in 2007 and 2008. Apparently, this prediction
was necessary for VA to project that it could reduce the backlog with
the resources it requests in the budget. VA provides this overview at
page 6A-2 of Volume II of its budget submission:
The 2008 budget provides resources to timely and accurately
process a claims workload that continues to increase in
quantity and complexity. Disability compensation and other
claims requiring a rating decision are projected to be 800,000
in 2008. If we receive 2007 funding near the levels passed by
the House and the Senate, it is projected that our pending
workload will decrease throughout 2007, ending the year with
369,980 claims pending in our inventory. In order to achieve
our timeliness and accuracy performance goals and to reduce the
backlog, hiring of additional FTE [full-time employee(s) or
equivalent(s)] is necessary.
The disability claims workload from returning war veterans as
well as from veterans of earlier periods has continuously
increased since 2000. VBA annual claims receipts grew 39
percent from 2000 to 2006--from 578,773 to 806,382, an increase
of 227,609. In 2007 and 2008, we anticipate a slight decrease
in receipts to 800,000. The complexity of the workload will
continue to grow, however, because veterans are claiming
greater numbers of disabilities and the nature of disabilities
such as post-traumatic stress disorder (PTSD), complex combat
injuries, diabetes and related conditions, and environmental
diseases are becoming increasingly more complex. For example,
the number of cases with eight or more disabilities claimed
increased 135 percent from 21,814 in 2000 to 51,260 in 2006.
(Emphasis added.)
The rise in claims receipts over the past 7 fiscal years and
anticipated receipts for 2007 and 2008 are represented in VA's graph at
page 6B-7:
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Given that discussion elsewhere in this same area of the budget
submission contradicts VA's statement that claims receipts will
decrease in 2007 and 2008, the continuing trends of an increase in
claims receipts year after year, the absence of any change in
circumstances that could be expected to reduce the number of claims
filed, and the absence of stated rationale for VA's expectation of
fewer claims in the current fiscal year and next year, this appears to
be an expedient projection.
The budget submission summarizes the consistent historical trend of
increasing numbers of claims received each year for the past several
years:
The number of veterans filing initial disability compensation
claims and claims for increased benefits has increased every
year since 2000. Disability claims from returning war veterans
as well as from veterans of earlier periods increased from
578,773 in 2000 to 806,382 in 2006, an increase of 227,609
claims, or 39 percent. In addition to the increased claim rate,
there are two other factors that drive future claims activity.
First, over this same period of time the number of veterans
receiving benefits has significantly increased, both in terms
of whole numbers and as a percent of the veteran population.
These veterans, like their predecessors, demonstrate similar
disability profiles. Orthopedic, mental health, cardiovascular,
endocrine, and hearing problems predominate. Most of these
conditions can be characterized as chronic progressive
disabilities resulting in repeat claims. Second, the average
level of disability for veterans on the rolls has increased
steadily in the last 5 years reflecting the aging population.
Similar to the chronic condition issue, the aging process is
likely to result in additional claims for increased benefits.
(p. 6B-6) During Fiscal Year 2006 alone, ``VA added almost 250,000
new beneficiaries to the compensation and pension rolls.'' (p. 6B-1)
From 2002 to the end of last year, VA lost ground in reducing the
backlog, with a substantial increase in the number of rating claims
pending: ``In 2003, VBA was successful in reducing the inventory of
pending disability claims to 253,000. . . . The pending inventory of
disability claims rose to 378,296 by the end of Fiscal Year 2006.''
(pp. 6B-3, 6B-4)
The added work from the increase in the sheer volume of claims has
been compounded by other factors: ``Since 2000, VBA has experienced a
steady increase in workload: in claims receipts, claims complexity, and
workload generated by improved direct contact with increasing numbers
of servicemembers and veterans.''
(p. 6B-3)
In discussing the ``2007 Workload Challenges,'' VA directly
contracts its prediction for fewer claims in 2007 and 2008: ``Ongoing
hostilities in Afghanistan and Iraq, and the Global War on Terrorism in
general, are expected to continue to increase the compensation
workload. (p. 6B-8) (emphasis added). VA explains:
More than 1.3 million active duty servicemembers, members of
the National Guard, and reservists have thus far been deployed
to Afghanistan and Iraq. Whether deployed to foreign duty
stations or maintaining security in the United States, the
authorized size of the active force, as well as the
mobilization of thousands of citizen soldiers, means that the
size of the force on active duty has significantly increased.
Studies by VA indicate that the most significant predictor of
new claims activity is the size of the active force. Department
of Defense data show there were more than 213,000 military
separations in 2005. These figures do not include the
demobilization of Guard and Reserve members and units that
remain part of the military. Historical trends suggest that
approximately 35 percent (over 74,000) of these separating
servicemembers will file a VA disability claim sometime in
their life. The claims rate for Gulf War Era veterans is
significant. In 2006, nearly 700,000 veterans and 15,000
survivors of this era received benefits, comprising the second
largest population of veterans receiving benefits after Vietnam
era veterans.
(p. 6B-8) Of course, we now have additional troops being deployed
to Iraq.
In addition to more claims proportionate to the increase in the
size of the active force, VA observes that greater numbers of veterans
on the compensation rolls means greater numbers of reopened claims:
The number of veterans receiving compensation has increased
by more than 400,000 since 2000, from just over 2.3 million
veterans to over 2.7 million at the end of 2006. The
compensation recipients, many of whom suffer from chronic
progressive disabilities such as diabetes, mental illness, and
cardiovascular disabilities, will continue to reopen more
claims for increased benefits in the coming years as they age
and their conditions worsen. During 2006, reopened disability
compensation claims comprised almost 55 percent of disability
claims receipts.
(p. 6B-8) (emphasis added).
In the 3 years from the end of 2003 to the end of 2006, attendees
at benefits briefings for separating servicemembers increased by more
than 87 percent, from 210,025 to 393, 345. VA expects to further expand
its outreach efforts to servicemembers and veterans, which it naturally
expects to result in an increase in the volume of claims:
VA has increased outreach to active duty personnel and we
must continue to expand our efforts. These outreach efforts
result in significantly higher claims rates. In 2004, the
greatest increase in rating receipts was in original claims--an
increase of 17 percent (from 167,105 in 2003 to 194,706 in
2004). Original claims increased by an additional 8 percent (to
210,504) in 2005 and by an additional 3 percent (to 217,343) in
2006, which is a 30 percent increase over the last 4 years. We
believe these increases are directly related to our aggressive
outreach programs and that the increases will continue.
. . .
We anticipate the same high level of commitment in future
years. Therefore, we expect the outreach hours and claims rate
for separating servicemembers to continue to increase.
. . .
Outreach efforts have been expanded to reach veterans,
particularly older veterans, who may not be aware of the
benefits to which they are entitled.
(pp. 6B-9, 6B-10) (emphasis added)
VA suggests that legislation authorizing Combat Related Special
Compensation (CRSC) and concurrent receipt of retired and disability
pay (CRDP) creates a potential for added workload:
Today, more than 54,000 military retirees receive [CRSC]. The
military is adding between 1,500 and 2,000 retirees to the CRSC
rolls monthly. This benefit and Concurrent Retired and
Disability Pay (CRDP), another DOD program that permits partial
to total restoration of retired pay previously waived to
receive VA compensation, further contribute to increased claims
activity. These claims are exceptionally complex, involving
significant coordination with service retired pay centers to
determine if retroactive benefits are payable. . . .
. . . Nearly 194,000 retirees receive CRDP. The number of
military retirees receiving VA compensation has increased to
more than 819,000 since the advent of these programs. There is
now significant incentive for retirees receiving compensation
to file claims for increased benefits, as the increased amounts
may no longer be subject to offset. Additionally, the total
number of retirees as of July 2006 was 1,812,108, meaning that
only 45 percent of military retirees now receive benefits.
There are over 990,000 who could potentially still file claims
due to CRSC and CRDP.
In 2007, VA anticipates significant workload to result from
the ongoing CRSC and CRDP programs.
(p. 6B-10) (emphasis added)
The budget submission notes that two court decisions may
substantially increase VA's workload. In Haas v. Nicholson, the court
held that Vietnam veterans who served in the waters offshore are
entitled to the presumption of exposure to herbicides. VA has appealed
the Haas decision, but estimates a total of 187,208 claims will be
received; 25,000 in 2007 and the remaining 162,208 in 2008 if the
decision is not overturned. In addition, a recent ruling by the Federal
District Court for the Northern District of California in Nehmer v.
U.S. Department of Veterans Affairs has extended the reach of the Agent
Orange Settlement Agreement to Chronic Lymphocytic Leukemia based upon
the extension of the lapsed Agent Orange Act. VA states it has
identified almost 1,500 cases that must be reviewed and readjudicated.
Under the court's order, VA must mail an outreach notice to
approximately 26,000 additional claimants. VA is required to review and
readjudicate cases for those claimants who respond to the mailing. VA
notes that, due to the unique rules in the Nehmer settlement and the
stringent time requirements imposed, these cases require significantly
more development and management oversight than normal claims. They also
require priority processing. (p. 6B-11)
The budget submission also explains how the workload continues to
increase due to increases in the number of disabilities claimed,
increasing complexity of the claims, and added judicially imposed
procedural steps, primarily to fulfill VA's duty-to-assist obligation.
Some of these observations from the budget submission are as follows:
``The number of disabilities claimed by veterans has
increased significantly. The number of directly claimed conditions
increases the number of variables that must be considered and
addressed, making the claim more complex. Multiple regulations,
multiple sources of evidence, multiple potential effective dates and
presumptive periods, preparation of adequate and comprehensive Veterans
Claims Assistance Act notice, as well as adequate and comprehensive
rating decisions increase proportionately, and sometimes exponentially,
as the number of claimed conditions increases.''
``Combat and deployment of U.S. forces to underdeveloped
regions of the world have resulted in new and complex disability claims
based on environmental and infectious risks, traumatic brain injuries,
complex combat injuries involving multiple body systems, concerns about
vaccinations, and other conditions.''
``VA has started to see increasingly complex medical cases
resulting in neuropathies, vision problems, cardiovascular problems,
and other issues directly related to diabetes. As previously discussed,
much like original claims with more than eight claimed disabilities,
diabetes claims routinely present multiple variables with which the
rating specialist must deal. If secondary conditions are not claimed,
the rating specialist must be alert to identify them. This increasing
complexity of disabilities adds to the increased complexity of our
workload and the resources needed to process it.''
``The number of veterans submitting claims for post-
traumatic stress disorder (PTSD) has also grown dramatically and
contributed to increased complexity in claims processing. From 1999
through 2006, the number of veterans receiving compensation benefits
for PTSD has increased from 120,000 to nearly 270,000. These cases
present unique processing complexities because of the evidentiary
requirements to substantiate the event causing the stress disorder.''
``The Veterans Claims Assistance Act (VCAA) of 2000 has
significantly increased both the length and complexity of claims
development.''
(pp. 6B-11, 6B-13) All of this signals a continuing trend of more
work.
VA points out that this increasing complexity in the workload
alone--i.e., with a projected decline in the number of claims receipts
for 2007 and 2008--require the additional employees it requests: ``More
FTE are needed to complete claims in an accurate and timely manner due
to the greater number of disabilities veterans now claim, the
increasing complexity of the disabilities being claimed, and changes in
law and process.'' (p. 6B-1) This is the basis for the increase in
employees VA requests for 2008:
In summary, the number of conditions claimed, the nature of severe
traumatic multiple body system combat injuries, highly complex medical
conditions, and enhanced legal requirements substantially increase the
complexity of the claims process and claims decisions. The resources
required to enable us to keep up with the increasingly complex workload
are, therefore, significantly greater.
(p. 6B-14)
VA also admitted that staffing levels in the current year are
insufficient to gain ground on the backlog: ``The current staffing
levels do not enable VA to reduce the pending claims inventory and
provide timely service to veterans.'' (p. 6B-4) VA hopes to reduce the
backlog some during this fiscal year through ``near-term workload
reduction initiatives'' funded with carryover funds from 2006:
``Special near-term workload reduction initiatives are being undertaken
in 2007 to increase decision output and stem the upward climb of the
pending inventory. These initiatives are being funded through the use
of carryover funds from 2006. . . . '' (p. 6B-4) VA will bank on these
same initiatives to reduce the backlog in 2008: ``Special near-term
workload reduction initiatives undertaken in 2007 that include
employment of rehired annuitants and expanded use of overtime will
continue into 2008, enabling us to increase decision output. With these
initiatives, we project that more than 840,000 veterans will receive
decisions on their disability claims in 2008. . . . '' (p. 6B-1).
Again, all of this is premised on a decrease in the number of claims
received during 2007 and 2008.
VA notes that increased claims receipts result in increased
appellate workloads downstream: ``As claims receipts and the number of
beneficiaries on our rolls increase, the appeals and other workloads
also increase. This significantly increases our resource
requirements.'' VA received 18,000 more claims in 2006 than in 2005,
with an increase of only 5 direct program FTE for 2007. With its near-
term workload reduction initiatives, VA projects it will increase the
number of rating decisions made from 774,378 in 2006 to 808,316 in
2007. (pp. 6B-4, 6B-7) In turn, that will increase its appellate
workload:
As VBA renders more disability decisions, a natural outcome
of that process is more appellate work from veterans and
survivors who disagree with various parts of the decision made
in their case. Veterans can appeal decisions to deny service
connection for any conditions claimed and disposed of by a
denial. They may also appeal the effective date of an award and
the evaluation assigned to a disability. In recent years, the
appeal rate on disability determinations has climbed from an
historical rate of approximately 7 percent of all disability
decisions being appealed to a current rate that ranges from 11
to 14 percent. Thus, the 808,316 projected disability decisions
in 2007 are expected to generate between 88,000 and 113,000
appeals. The projected 840,320 completed disability decisions
in 2008 will likely generate between 92,000 and 117,000
appeals. At the end of 2006 there were more than 133,000
appeals pending in field stations and the Appeals Management
Center (AMC). In addition, there were slightly less than 31,000
appeals pending at the Board of Veterans' Appeals.
This increase in appellate workload seriously impacts our
ability to devote resources to initial and reopened claims
processing. Appeals are one of the most challenging types of
cases to process because of their complexity and the growing
body of evidence that must be reviewed in order to process
these claims. In 2001, we received 39,000 notices of
disagreement, the initial step in the appeals process. From
2003 to 2006, notices of disagreement exceeded 100,000 each
year. The number of appeals received is proportionate to the
number of decisions made. As workload and the number of
decisions made increase, so too will the number of appeals.
Likewise, the number of actions taken in response to our
appellate workload has increased. In 2001, we processed more
than 47,600 statements of the case and supplemental statements
of the case. In 2006, this number increased to more than
134,000 statements of the case and supplemental statements of
the case.
(pp. 6B-14, 6B-15)
The budget submission projects rating decision output per FTE at
102.8 decisions in 2007 and 101 decisions per FTE in 2008. (p. 6B-4)
The budget submission for Fiscal Year 2007 had projected 108 decisions
per FTE. (Vol. 2, p. 5B-5) With the projected decrease in claims
receipts and its estimated increase in the number of rating decisions
in both 2007 and 2008, VA projects that it will reduce the backlog:
In 2007, we anticipate a slight decrease in disability claims
receipts over the 806,382 claims received in 2006, to 800,000
claims. The one-time workload increase in 2006 that resulted
from the six-state outreach initiative (approximately 8,000
claims) is not projected to continue into 2007 and 2008. With
an FTE level of 7,863 and our near-term workload reduction
initiatives, we estimate 808,316 completed claims and an end-
of-year pending [rating] inventory of 369,980.
In 2008, we anticipate disability claims receipts will remain
level with 2007. Based on a direct FTE level of 8,320 and our
near-term initiatives, we estimate completed claims will
increase to 840,320 and the pending inventory will decrease to
329,660 by the end of 2008.
(p. 6B-7) If the 8,000 claims from the six-state outreach
initiative are subtracted from the 2006 total of 806,000, there was
still an increase of 10,000 claims receipts in 2006 over the 788,000 in
2005. Again, VA does not explain its prediction of a decrease in the
number of claims receipts in 2007 and 2008, which contradicts its
projection in its budget submission for Fiscal Year 2007 that, for
2007, ``we anticipate receipts will increase 2 percent over the 2006
projected receipts.'' (Vol. 2, p. 5A-2)
VA projects that it will reduce the average days to process rating-
related compensation and pension actions from 177 days in 2006 to 160
days in 2007 and 145 days in 2008, with a target of 125 days. VA
projects that its national accuracy rate for core rating work will
improve from 88 percent in 2006 to 89 percent in 2007 and 90 percent in
2008, with a strategic target of 98 percent. (p. 6B-24, 6B-25)
As with this year's budget submission, VA has maintained in its
budget submissions for previous years that it will improve claims
processing and reduce the backlog with the resources it requests. For
example, in its budget submission for Fiscal Year 2006, VA projected
its rating decision output for Fiscal Year 2006 would be 109 cases per
direct labor FTE and 825,000 total. VA projected that it would reduce
the pending inventory of rating claims from 321,458 to 290,000 by the
end of 2005, and that it could further reduce the pending inventory to
282,876 by the end of 2006. (Vol. 1, pp. 2A-10, 2A-11.) VA estimated
the average time to complete rating-related actions would be 145 days
in 2006, with a strategic target of 125 days. It predicted a national
accuracy rate for core rating work of 90 percent, with a strategic
target of 98 percent. (p. 2A-14) However, as noted, its rating decision
output per FTE was 98.5, its total rating production was 774,378
decisions, and it ended Fiscal Year 2006 with an inventory of 378,296
claims with an average processing time of 177 days and a national
accuracy rate of 88 percent. Actually, the gap between VA's predicted
output for 2006 and its performance is wider than indicated by these
numbers because it projected reducing the backlog to 282,876 claims
despite the expectation that it would receive 818,076 claims ( p. 2A-
10) rather than the 806,382 that it actually received. With the
resources VA has requested, it has been unable to reduce the backlog.
Instead it continues to grow.
A repetition of VA's summary of the trend of annual increases in
the volume of claims along with its acknowledgment that it has been
unable to make progress in reducing the backlog since 2003 provides a
more accurate picture upon which to base expectations for 2007 and
2008, in our view:
Since 2000, VBA has experienced a steady increase in
workload: in claims receipts, claims and complexity, and
workload generated by improved direct contact with increasing
numbers of servicemenbers and veterans. If resources are
insufficient to handle this increased workload, our pending
claims inventory rises and presents difficult management
challenges. For example, disability claims from returning war
veterans, as well as from veterans of earlier periods,
increased by 39 percent from 2000 to 2006. In 2003, VBA was
successful in reducing the inventory of pending disability
claims to 253,000. Since 2004, increased claims and court
decisions requiring new procedures and readjudication of claims
have precluded VBA from sustaining previous gains.
(p. 6B-3) As of February 17, 2007, the number of rating cases
pending was 401,701 of which 111,575 had been pending over 180 days. We
are now approaching half way through Fiscal Year 2007 and not moving
toward VA's projection of reducing the backlog to 369,980 rating
claims.
Discussing external factors that affect the workload, VA observed:
``Negative impact could be realized if workload receipts are
significantly higher than anticipated. . . . '' (p. 6B-30) It appears
that VA's projection on claims receipts was wrong or its plan for
reducing the backlog is not working.
As we have consistently said, quality is the key to timeliness.
Timeliness follows from quality because omissions in record
development, failure to afford due process, and erroneous decisions
require duplicative work, which adds to the load on an already
overburdened system. Quality is achieved with adequate resources to
perform necessary comprehensive and ongoing training, to devote
sufficient time to each case, and to impose and enforce quality
standards through effective quality assurance methods and
accountability mechanisms. VA has simply not had the resources
necessary to achieve the level of quality required to avoid
unacceptable error rates, increased numbers of appeals, and the
consequent overload that causes backlogs and delays in claims
dispositions.
In connection with its review of variances in average annual
compensation payments among the states, VA's Inspector General surveyed
rating veterans service representatives (RVSRs) and decision review
officers (DROs) to obtain their input on issues that affect the rating
of disability compensation claims. RVSRs and DROs expressed generally
positive opinions of the quality of their training, but their responses
indicated training has not received high priority. Department of
Veterans Affairs Office of Inspector General, Rep. No. 05-00765-137,
Review of State Variances in VA Disability Compensation Payments 58
(May 19, 2005). In a recent survey of VA raters conducted by the Center
for Naval Analysis (CNA) for the Veterans' Disability Benefits
Commission, 32 percent of those responding said that getting needed
training was among the top three greatest challenges they face.
However, VA appears to be doing the best that it can to provide better
training to improve quality with the resources it has been given. VA
outlines its enhanced training programs in its Fiscal Year 2008 budget
submission at page 6B-17. Unquestionably, training is essential, but
effective training programs require resources:
While additional claims processors are critical to deal with
this workload, the quality of claims decisions and the services
provided is also critical. VBA's robust training program is the
key to improving the quality and consistency of our decisions
and will enable us to be flexible and responsive to changing
workload volumes. VBA is engaged in an ongoing effort to
improve its training systems for new employees and to raise the
skill levels of its existing staff. Improved quality and
consistency require resources dedicated to providing employees
with more and better training, up-to-date tools, and IT systems
to support their decisions.
(p. 6B-6) The most essential resource is experienced and
knowledgeable personnel devoted to training: ``Our need to continually
enhance our national quality assurance and training programs
necessitates additional staffing that will improve consistency,
quality, certification, and timeliness.'' (p. 6B-17) If experienced
adjudicators must spend part of their time training other employees,
there must be more employees overall to avoid falling further behind in
battling the backlog.
Regarding sufficient time to properly develop and decide a claim,
RVSRs and DROs surveyed by the Inspector General's Office thought VA
management's emphasis on quantity rather than quality had an adverse
effect upon their ability to properly dispose of claims:
RVSRs and DROs believe their objectives are different from
those of their managers. We asked them to rank the importance
of 16 potential objectives. Their responses indicated that when
rating claims their most important objectives are complying
with applicable criteria, granting the highest ratings allowed,
and ensuring they have sufficient information before making
decisions. We also asked them to rank the importance to their
managers of 15 comparable objectives. Their responses indicated
that they believe the most important objectives for their
managers are maximizing the number of ratings done each day,
reducing the backlog of pending work, and improving the
timeliness of ratings.
Survey responses showed that RVSRs and DROs are concerned
about their production standards, and many respondents
indicated that the need to meet production standards adversely
affects the quality of their work.
Forty-seven percent said it is generally difficult or
very difficult to meet their daily production standards; 22.5
percent said it is generally easy or very easy.
Forty-nine percent strongly disagreed or disagreed
somewhat with the statement that they have no difficulty
meeting their production standards without sacrificing quality;
30.5 percent strongly agreed or agreed somewhat with that
statement.
Fifty-seven percent strongly agreed or agreed somewhat
with the statement that they have difficulty meeting their
production standards if they make sure they have sufficient
evidence for rating each case and thoroughly review the
evidence; 24.1 percent strongly disagreed or disagreed somewhat
with that statement.
VA OIG Report at 60?61. Among the raters responding to the CNA
survey, 85 percent said that having time to process a claim was one of
the top three greatest challenges.
The survey of RVSRs and DROs by VA's OIG cited insufficient
staffing as the cause for too little time: ``Most RVSRs and DROs do not
believe [VA Regional Offices] have sufficient rating staff. Sixty-five
percent indicated that the rating activities in their offices have
somewhat smaller or much smaller staffs than needed to provide timely
and high quality service.'' VA OIG Report at 61. The OIG report quoted
the following narrative remark from the survey: ``Although management
wants to meet quality goals, they are much more concerned with
quantity. An RVSR is much more likely to be disciplined for failure to
meet production standards than for failing to meet quality standards.''
VA OIG Report at 61
Sufficient staffing permits sufficient time to properly develop and
decide claims and sufficient time to devote to training without
allowing the backlog to grow. Discussing survey responses from RVSRs
and DROs, the OIG report at page 61 noted: ``The most frequently
discussed issue, mentioned by 193 respondents, was management's
perceived emphasis on production at the expense of quality. The second
most frequently discussed issue, mentioned by 44 respondents, was the
need for more and better training.''
VA's quality assurance tool for compensation and pension claims is
the Systematic Technical Accuracy Review (STAR) program. Under the STAR
program, VA reviews a sampling of decisions from the regional offices
and bases its national accuracy measures on the percentage with errors
that affect entitlement, benefit amount, and effective date. If STAR
were being used effectively, we question why VA did not detect the
substantial variations in average annual compensation payments from
state to state brought to light by the news media and thereafter
investigated by the VA Office of Inspector General in 2005.
Inconsistency signals outright arbitrariness in decisionmaking,
uneven or overall insufficient understanding of the governing criteria
or rules for decisions, or rules which are vague or overly broad so as
to allow them to be applied according to the prevailing mindset of a
particular group of decisionmakers. Obviously inconsistencies must be
detected before the cause or causes can be determined and remedied.
To address concerns about substantial variations in average annual
compensation payments among the states, VA's OIG reviewed compensation
awards from the six states with the highest average annual payments
(``high cluster'') and the six states with the lowest average annual
payments (``low cluster'') finding that veteran demographics and
inconsistent rating decisions may account in part for the variations.
OIG also found that claims processing practices, the quality of
disability examinations, staffing levels, production pressures, and
adjudicator experience and training may influence payment levels. On
average, veterans in the high cluster states had more service-connected
disabilities and higher disability ratings than veterans in the low
cluster. In general, training was a higher priority, adjudicators were
more experienced and had less difficulty applying the disability rating
schedule, disability examinations were judged better, and error rates
were lower in the high cluster states. Adjudicators in the high cluster
states took longer to adjudicate claims, although the pressing backlogs
were smaller there and they shipped fewer cases to other offices for
adjudication. High cluster states had higher percentages of (1)
represented veterans, who were shown to be higher compensated than
unrepresented veterans; (2) Vietnam veterans, who were shown to be
higher compensated than veterans of other periods; and (3) veterans of
the enlisted ranks, who were shown to be higher compensated than
veterans of the officer ranks. In the high cluster, a higher percentage
of veterans exercised their right to appeal than in the low cluster.
These findings suggest that the trend of lower payments in some states
may be due in part to lower proficiency in adjudication. Adequate
resources are essential to proficient claims adjudication.
The variations between veterans represented by service
organizations and unrepresented veterans were particularly marked. The
national averages showed that veterans represented by accredited
service organizations had substantially higher levels of compensation
than veterans without representation. The national average annual
payment for veterans with representation was $10,631, compared with a
national average of $4,406 for unrepresented veterans. All the states
in the high cluster had higher percentages of represented veterans.
Nationwide, 63.8 percent of the veterans receiving compensation were
represented. In the high cluster states, 69.5 percent of the veterans
were represented. In the low cluster states, 54.7 percent of the
veterans were represented. In the high cluster states, veterans with
representation had an average annual payment of $13,488. Represented
veterans in the low cluster states had an average annual payment of
$9,891, above the national average of $8,378 for all veterans. Though
well below the national average for represented veterans and below the
national average for all veterans, unrepresented veterans in the high
cluster states had an average annual payment of $5,637, compared with
only $3,862 for unrepresented veterans in the low cluster states. Thus,
represented veterans in the high cluster states received an average
annual payment that was $7,644 higher than the average annual payment
of unrepresented veterans in low cluster states. The most telling fact
here is that the average annual payment of $9,891 for veterans in the
six states with the lowest average annual compensation payments who had
service organization representation was higher than the national
average of $8,378 for all veterans. This would suggest that veterans
service organization representatives are serving in a role of quality
assurance, in addition to assistance in thorough record development.
As a result of these revelations about variances, VA has undertaken
an effort to identify unusual patterns of variances and assess the
degree of consistency among its regional offices to enable it
strengthen guidance and target training to problem areas: ``C&P Service
has begun a process of identifying unusual patterns of variance by
diagnostic code, and then reviewing selected disabilities to assess the
level of decision consistency among regional offices. The outcome of
these studies and STAR accuracy reviews will be used to identify the
need for additional guidance and training to improve consistency and
accuracy, as well as to drive procedural or regulatory changes.'' In
addition, VA will conduct site surveys for compliance with directives.
(p. 6B-17)
The Board of Veterans' Appeals (BVA) now identifies, by the
specific reason, the number of cases it remands each year to correct
deficiencies in the record or for due process. In Fiscal Year 2006, BVA
remanded claims for a medical opinion in conjunction with an
examination in more claims than for any other reason. This data should
aid VA in identifying and remedying deficiencies that add to the cycle
of rework, and we hope this information is being utilized for that
purpose, along with STAR results and other efforts for improvement.
While VA's increased efforts are a move in the right direction, we
believe they still leave a gap in quality assurance for purposes of
individual accountability for quality decisionmaking. To complement its
STAR program for measuring quality at the national level, VA announced
in the year 2000 a new initiative for quality review at the individual
level. Acknowledging that management needed a tool to consistently
monitor individual performance, VA created the ``Systematic Individual
Performance Assessment'' (SIPA) program. Under this program, VA would
review an annual sample of 100 decisions for each adjudicator to
identify individual deficiencies, ensure maintenance of skills, promote
accuracy and consistency of claims adjudication, and restore
credibility to the system. The reviewers would perform related
administrative functions, such as providing feedback on reviews,
maintaining reports, and playing a role in employee development and
ongoing training. Unfortunately, VA abandoned this initiative during
2002, and proficiency is now apparently subjectively assessed by
supervisors based on their day-to-day perceptions of employee
performance. Without any actual systematic review of samples of an
individual adjudicator's decisions, deficiencies are more likely to go
undetected and unremedied. We understand that the culprit behind
abandonment of SIPA was inadequate resources. Without any quality
assurance review on the individual level, VA is unlikely to impose
effective accountability down to the individual adjudicator level,
where it must go if optimum quality is to be attained. We believe
today's VA workforce is conscientious and desires to make the best
claims decisions possible, but it needs the time, training, and tools
to do so, and the tools include a source of direct feedback from
individualized quality reviews. Congress must provide VA management
with the necessary resources, and VA management must create a culture
of quality and make a genuine commitment to the mission of providing
``all possible benefits under the law to eligible claimants in a
timely, accurate, and compassionate manner.''
As noted, a natural consequence of increased numbers of claims is
that the volume of pending appeals and time for resolution of appeals
has also increased in recent years. The natural increase in the volume
of appellate workload is compounded by the effects of not sufficiently
increasing staffing at regional offices to meet increased claims
volumes and complexity, which adds to the overload and prolongs the
processing times for appeals at the regional office level. As
indicated, at the end of 2006, there were more than 133,000 appeals
pending in VBA field stations and VBA's Appeals Management Center
(AMC). This was up from the nearly 130,000 pending at the end of 2005.
Another consequence is increased numbers of remands, which primarily
impacts on workload, timeliness, and resource needs at the AMC.
However, with a joint effort by VBA and BVA to reduce the number of
remands, the number of cases on remand declined from 31,645 at the end
of 2004 to 21,229 at the end of 2006, according to VA's budget
submission for Fiscal Year 2008. (Vol. II, p. 7C-4) Most remands are
processed by the AMC, which had 15,875 cases on hand on February 22,
2007. Our employees who deal with the AMC and our employees at BVA
generally give AMC high marks for quality.
VBA field offices resolved 74,440, or 72 percent, of the 103,212
appeals resolved in 2006 without necessity for action by BVA. VBA
resolved another 3,749, or 10 percent of the total, on remand. Although
we do not have current VA data on the percentage of appeals favorably
resolved by DROs, we suspect it is substantial. The DRO program has
been a success story since it was instituted as a part of VBA's
Business Process Reengineering program several years ago.
In 2006, BVA decided 25,023 cases on the merits according to the
budget submission and remanded 12,487 according to the Report of the
Chairman of BVA for Fiscal Year 2006. (p. 20) The Report of the
Chairman summarized the Board's production for Fiscal Year 2006 as
follows:
The Board issued 39,076 decisions in Fiscal Year 2006, an
increase of 4,901 over Fiscal Year 2005, when we issued 34,175
decisions. [Board members] conducted 9,158 hearings, which is
an increase of 582 hearings held over Fiscal year 2005. The
majority of the line [Board members] exceeded their
productivity goals and traveled to at least three [regional
offices] to conduct 1 week of Travel Board hearings at each
site. However, the number of cases pending before the Board at
the end of Fiscal Year 2006 was 40,265, which is almost a 3,000
case increase over the 37,539 appeals that were pending at the
end of Fiscal Year 2005. This increase occurred despite the
fact that the Board issued almost 5,000 more decisions in
Fiscal Year 2006 than the previous year. If we continue to
receive the same high number of appeals and hearing requests
each year, the ability to conduct hearings and decide appeals
on a timely basis with the current business plan strength of 56
[Board members] will present a challenge.
(p. 3)
The budget submission for Fiscal Year 2008 describes BVA's quality
assurance program as one that looks at all aspects of decision quality
but focuses on substantive qualities for reporting purposes:
BVA has a formal quality review program to review the quality
of decisional products and to identify areas in which
professional training is needed. In this quality review
process, an ongoing, statistically valid sample of BVA
decisions is reviewed and components deemed essential to a
quality appellate decision are assessed on a pass/fail basis
according to established standards. The five areas examined and
scored are: (a) identification of issues; (b) findings of fact;
(c) conclusions of law; (d) reasons and bases/rationale for
preliminary orders such as remands; and (e) due process. A
quantified baseline for decision quality was established for
the first time at the outset of 1999. This provided the Board a
foundation for establishing quantified decision quality goals
and pursuing continuous improvement in the quality of decisions
through repeated measurements. In accordance with a GAO
recommendation, we consider only substantive deficiencies in
our quality assessment. However, while the primary focus is on
identifying, quantifying, and correcting substantive errors, we
still address minor deficiencies and seek to improve all
aspects of our decisions. Areas of deficiency highlighted
through this process are used to determine BVA training needs.
(p. 7C-5) BVA reported a ``Deficiency-free Decision Rate'' of 89.0
percent for 2005 and 93.0 percent for 2006. Its target for 2007 and
2008 is 92.0 percent. (p. 7C-5)
VA uses two measures for timeliness in appeals processing.
``Appeals Resolution Time'' is the average time from the initiation of
the appeal by receipt of a notice of disagreement and the final
decision, either by VBA or BVA. ``BVA Cycle Time'' is the time from
receipt of the appeal by BVA until dispatch of a BVA decision,
excluding the time the case was with the appellant's service
organization representative. Where the first measure is the average
total time for an appellant to receive a decision, the second reflects
more directly on BVA's timeliness.
Timeliness in appeals processing declined in 2005 and 2006. Appeals
resolution time increased from 529 days in 2004 to 622 days in 2005 and
657 days in 2006. VA projects that it will further grow to 685 days in
2007 and 700 days in 2008. BVA cycle time increased from 98 days in
2004 to 104 days in 2005 and 148 days in 2006. VA projects that it will
improve to 105 days in 2007 and 104 days in 2008. (p. 7C-2)
Given that VBA resolved nearly three-quarters of appeals decided in
2006 without the added time the case would have otherwise been before
BVA, the appeals resolution time was much shorter than for those cases
that were decided by BVA. According to the timeline in the Report of
the Chairman, in a case decided by BVA, the time between the receipt of
the notice of disagreement and issuance of a BVA decision was 971 days.
(p. 16). The Chairman's report indicates the average elapsed time
between receipt of a notice of disagreement and issuance of a statement
of the case was 188 days; between issuance of a statement of the case
and receipt of the appellant's perfection of the appeal was 42 days;
between perfection of the appeal and field office certification of the
appeal to BVA was 489 days; and between receipt of the certified appeal
and issuance of a BVA decision was 252 days, for the total of 971.
The budget submission requests that the staffing level for C&P
Service be increased from the 7,858 FTE authorized in 2006 to 8,320 in
2008. (p. 6A-10) Considering that VA is falling further behind in 2007
despite special efforts to reduce the backlog and given the probability
that claims receipts will increase, this staffing level is likely to be
inadequate, just as the current staffing level is inadequate, a fact VA
admits. The budget submission requests that the BVA staffing level be
increased from the 2006 level of 452 FTE to 468, an increase of 16. (p.
7C-10) As noted, with its current staffing and that requested for 2008,
BVA expects its quality to suffer a slight decline from 2006 levels.
To correct the problems throughout, we believe Congress must invest
additional resources primarily at the front end of the process to
reduce the additional work required downstream and to break the vicious
cycle in which the push for quantity and the expense of quality results
in more errors and more rework adding ever more to the backlog.
We appreciate the opportunity to present our views on this most
important matter, and we hope this information will be helpful to the
Committee as it seeks to improve services to disabled veterans.
______
Response to Written Questions Submitted by Hon. Barack Obama
to Rick Surratt, Deputy National Legislative Director, Disabled
American Veterans
Question 1. In an ideal world, and I know that's a big leap, what
would be the aspiration of the VBA and Board of Veterans' Appeals,
whether in terms of claims worker to Veteran ratios, in terms of
turnaround time, or some other measure to indicate that we are doing
right by our Veterans. In short, and I know I'm putting you on the
spot, what would an ideal VBA look like?
Response. The problem is well known and longstanding. The volume of
claims received exceeds the volume of claims decided. With more work
coming in than is going out, the inventory of claims pending
accumulates into a backlog that cannot be timely processed. The reason
for this is a claims volume that exceeds VA's production capacity. This
imbalance is a product of increasing numbers of claims compounded by
increasing complexity in the nature of many of the claims without a
corresponding increase in personnel to meet workload demands. Rather
than address this problem with increased resources, VA has been forced
to push its decisionmakers to produce more, which, in turn, requires
that less time be devoted to developing and deciding claims.
Inevitably, quality suffers, and the necessity to correct mistakes adds
even more to the workload.
VA cannot control the volume and complexity of claims for
disability benefits. Unless we remove our Armed Forces from the Global
War on Terrorism and the perilous circumstances inherent in any
military environment or reduce or eliminate benefits for disabled
veterans, Congress cannot impact the volume or complexity of claims.
Neither of those are realistic or acceptable solutions. The problem has
persisted and will continue to persist, perhaps even worsen, if claims
receipts are not forecasted accurately and resource needs are not
stated honestly.
The solution begins with an increase in personnel. Along with that
must come better training and the development of better quality control
measures. Even for VA, determining resource needs is not an exact
science, but the problem has been that VA's resource requests have been
tailored to the Administration's budget targets rather than being a
true approximation of the personnel needed to handle the work expected.
The challenge for Congress and stakeholders, such as the
organizations preparing The Independent Budget, in making an
independent assessment of VA's needs is that they must look behind the
Administration's assessment and its sometimes expedient assumptions to
the hard data and historical trends to determine if the
Administration's projection is out of line with what can reasonably be
expected, given the workload trends, the VA's past production numbers,
and VA's success or failure to reduce the backlog with the resources it
had in recent years. In its estimates of future claims receipts, VA can
easily adjust the numbers to suit the limits imposed upon it by the
Office of Management and Budget, but it cannot as easily manipulate the
numbers with its historical reporting of workloads and its performance
relative to those workloads. Those circumstances place us in a better
position to question the legitimacy of VA's request than to make our
own more exact determination of VA's needs. Nonetheless, by looking at
the historical workload trend, current factors that may influence that
trend, and past performance, we can roughly project the number of
employees necessary to produce the number of decisions required to
dispose of the incoming workload and begin to make some gains in
reducing the backlog. That method assumes no appreciable increase in
worker productivity or administrative efficiency, such as VA often
assumes in its calculations, because experience does not justify it.
The shortcoming is that we must rely on VA data, use VA's methodology,
and use recent experience to adjust VA's assumptions. While the
resulting approximation may prove to have missed the mark somewhat, it
almost invariably demonstrates that VA's budget request is too low, and
the higher projections of The Independent Budget are vindicated year
after year by VA's repeated failure to meet its stated timeliness and
backlog reduction goals.
Unless VA's budget requests start to provide a more honest
assessment of the resources needed, Congress must rely on its own
judgment, aided by stakeholder input such as that from The Independent
Budget. Staffing levels can be determined in terms of ratios between
projected claims volume and individual employee production
expectations. Those expectations can be arrived at by looking at past
performance. An important consideration is to be mindful that, because
VA is already far behind, it will need more personnel to catch up than
to stay even once the backlog has been reduced to the optimum pending
inventory of claims.
The optimum pending inventory of claims would be the minimum
required to ensure a steady workflow and avoidance of employees being
idled by a lack of work. This volume would determine the optimum time
that a pending claim would be in the queue awaiting action. Beyond
that, the optimum processing time from receipt of a claim to a decision
and payment of benefits would be determined by optimum times for
responses to requests for records from the Department of Defense, VA,
and private entities along with the task times for each action in
claims development and decisions. Beyond a point of optimum efficiency,
these turnaround and task times would be irreducible.
To set accurate standards for optimum claims inventories and
processing times, VA must refine its methods for quantifying its
workload. A claim for service connection involving three separate
disabilities might take no more time than a claim for service
connection of a single disability as far as obtaining military medical
records or other record development is concerned, but the three-issue
claim can logically be expected to require more time for a decision
than a single-issue claim. Rating the severity of a disability
involving subjective symptoms and necessary judgments can be expected
to require more time than one in which the disability is measured more
mechanically by objective signs. Rather than treating all claims as
equal, these kinds of variables must be taken into account if VA is to
accurately measure its workload for purposes of planning and requesting
resources.
With staffing matched to workload, there would be adequate time to
completely develop and carefully decide a claim thereby avoiding the
counterproductive effect of errors and rework. Naturally, the better
trained the employee the higher the likelihood that an accurate
decision can be made in a shorter time. An influx of new employees
would require substantial resources for proper training. VA simply
cannot afford to attack this problem by diverting experienced
adjudicators away from deciding claims to train new employees. Here, it
would seem that VA needs to standardize training, and centralize it to
the maximum extent practical. For necessary hands-on training at
regional offices, VA should have a staff dedicated exclusively to
training. VA has used rehired annuitants for training with some
success. Of course, newer employees could continue to seek advice and
assistance from experienced adjudicators working alongside them.
As we have testified, another essential element is individualized
quality reviews to enable VA to assess and improve individual
performance. The current STAR program measures quality on a national
and regional office level.
With adequate staffing, improved training, and better quality
control, VA can achieve quality. From quality, timeliness follows.
Until VA takes a comprehensive approach to studying and employing
methods to address all these interdependent elements of efficiency, we
do not believe it is possible to determine precisely in terms of days
what is achievable in claims processing timeliness goals, beyond those
irreducible minimums inherent in the process and its governing rules.
Until VA gets its backlog, and thus its quality, under control, BVA
will continue to need staffing sufficient to meet an increasing
appellate workload. With the problems fixed at the front end of the
process, the percentage of decisions appealed should decline. In
addition, the number of cases remanded for additional development
should decline. However, a mass adjudication system as large as VA's
cannot be expected to achieve perfection. We will continue to need a
strong appellate board within the administrative process, but the
primary focus should be on correcting deficiencies at the first level
of adjudication. In addition to correcting errors and deciding finer
points of law, BVA can serve as an important part of VA's quality
assurance program.
Question 2. The productivity of the compensation and pension staff
within the VBA is of great concern to all of us. Yet, how do we ensure
that we're setting the right targets and goals for them, without
creating the wrong incentives? How do we better give them the support
they need to apply the highest level of expertise and judgment on a
particular claim, while doing so efficiently?
Response. In production efficiency, there is always a balance
between thoroughness and time. Neither can be completely ignored in
favor of the other. Yet, as stated, VA must have adequate resources to
achieve quality first because it can never achieve real timeliness if
unacceptable error rates require rework, adding to the backlog and
appellate workload and resulting in protracted claims and appeals
processing times for those having an immediate and often urgent need
for the assistance they seek. Instead of a situation in which
timeliness follows from quality, it has been the other way around in VA
where the level of quality has depended on how much cases are
backlogged and how much pressure is put on to quickly decide cases for
production quantity. In the past, Congress has been somewhat
hypocritical in accepting the Administrations' inadequate resource
requests and criticizing VA for losing ground against the backlog.
Criticizing VA for poor timeliness without providing adequate resources
creates a strong incentive for managers to push for production at the
expense of quality. Again, Congress should provide the resources
necessary for a focus on quality through an adequate workforce,
adequate training, and an adequate quality assurance and feedback
program. Although achieving all of this will require an immediate
investment of money, it cannot be achieved immediately and will require
a longer investment of time.
To get a candid view from within VA, we posed these questions to a
former management employee who is in a position to understand more
specifically VA's real needs for the Compensation and Pension Service.
The following are the answers to questions
1 and 2:
Response to Question 1. 1VBA would need to increase its staffing
level in Compensation and Pension by nearly 23-25 percent from the
fiscal year 06 staffing level of 7858 FTE. VBA would need at least 9665
FTE (+23 percent), an increase of 1807 FTE. This 9665 FTE includes 9115
to develop and decide claims and appeals along with another 550 FTE to
prepare and deliver training and conduct regular (monthly) performance
reviews of the work. Given timeliness expectations (claims decided
within 120-180 average days), quality expectations (90 percent or more
of decisions are error free), consistency expectations (applying
national policy directives evenly for those decision criteria that
require judgment for issues of service connection and evaluation of
disabilities), additional staff is needed to meet these goals before we
even consider any productivity goals. Moreover, retirement and
attrition rates should average 6-8 percent over the next 2-3 years as
employees retire. This means that VBA should lose another 471 to 629
FTE per year which it will need to backfill/recruit in the coming 2-3
years in addition to the 1807 FTE to get to and maintain the overall
9665 FTE level in Compensation and Pension.
Finally, given the rising number of disabilities claimed per
veteran, coupled with the complexity of the current laws and
regulations, including the legal requirements governing the number of
requests and follow-up requests needed to fulfill VBA's ``duty to
assist'' in obtaining medical and other evidence, a significant
increase in staffing is needed in those positions that develop evidence
(VSR) and decide claims (RVSR). Consequently, just about all of the
increased staffing outside staff for the training and performance
reviews (1251 FTE) would go to strengthening these positions. Moreover,
VBA recent budget formulation models do not include the 550 FTE to
build necessary infrastructure for training and quality. If VBA's
staffing level in Compensation and Pension were increased by 25 percent
rather than 23 percent from fiscal year 06 levels, it would need yet
another 157 FTE or 9823 total FTE. If a mistake in staffing is made, I
would recommend the 25 percent increase rather than 23 percent given
the mission and the current situation. Attrition rates would quickly
bring VBA into equilibrium to prevent overstaffing for any length of
time.
Response to Question 2: Wrong incentives have been set in the past
and continue to be set. We all recognize that productivity is
important, but not at the expense of consistency, quality, and
timeliness. Stressing productivity goals is a big mistake and will
continue the problems we have seen with inconsistency of
decisionmaking, poor quality, and poor development of claims. Gathering
and evaluating evidence continues to be the major problems affecting
the timeliness and quality of VBA decisionmaking. Consequently, greater
emphasis should be placed on these aspects of the process and less on
productivity. VBA does not have any real data on the amount of work
that can be produced with quality levels that are reliable and
trustworthy. Stressing quality, consistency and timeliness first and
foremost would allow VBA to better set more realistic organizational
and individual productivity goals and standards. Finally, VBA needs
more staffing even if the number of claims decided each year remain
constant.
The increasing complexity of the work coupled with judicial
oversight ensure that more work effort (FTE) is needed to develop and
decide claims than was expended traditionally. The data continues to
show that more disabilities per claim are filed than in the past, more
claims per lifetime per veteran are being filed, and more effort is
being expended by VBA to gather evidence and explain decisions that it
did in the past. All of these factors require a completely different
approach to productivity and efficiency than has been taken in the
past. The traditional measure of productivity, end products taken, no
longer accurately reflects VBA work effort and must be abandoned as it
takes too big a toll on service levels, i.e., quality and consistency.
Chairman Akaka. Thank you very much, all of you, for your
statements.
Mr. Rowan and Mr. Surratt, you know that the VA has a
strategic goal of 125 days for a veteran to have his or her
claim rated. My question to you, with all your experience, is:
What is an acceptable amount of time for a veteran to have his
or her claim rated?
Mr. Surratt. Well, Mr. Chairman, I will not give you an
exact number of days, but I will tell you--I think I can tell
you how we should figure that. A veteran files a claim, and
there is a certain amount of turnaround time, the mailing back
and forth between the VA and the veteran, an average time for
that. There are task times, how long it takes to look at a
record to see how much it needs to be developed, and those
things can be determined. Task times, how long it takes to make
a decision on a typical claim. There are statutory times that
the VA has to give the veteran a certain amount of time to
respond. So there is an irreducible amount of time. Where the
real problem is, is the amount of time that these cases spend
in the queue waiting to get to the next action.
You heard someone mention this morning about reducing the
amount of time that veterans get to 30 days to do something. If
you look at the time line on appeals, for example, veterans,
once they file a Notice of Disagreement, VA sends them a
statement of the case, and they have 60 days to respond to that
statement of the case. I think the average time that veterans
respond is about 42 days.
But then after the appeal is certified at the regional
office and theoretically ready for a decision by the BVA--I
don't remember how many days it is, but it is something like
600 days between the date it is certified and the date that it
goes to the Board of Veterans' Appeals. That is where your
delays are. A hundred and twenty-five days to me does not sound
unreasonable. The amount of time it should take to decide a
case is the optimum amount of time that it needs to stay in the
queue and adding on these task times that are irreducible.
You heard Admiral Cooper say that you need to have a
certain amount of backlog. I mean, you need a steady workflow.
You do not want to ever be in the situation where you are
totally caught up because you have people idle. But there is
also an optimum amount of backlog that you need to keep that
workflow steady, and those things can be determined. That is
not exactly rocket science, but where you can identify the
delay is where these cases sit idle between these steps, and
the reason they sit idle is because VA does not have--they are
backed up, and they wait there forever for the next step to be
taken.
So that is where you need to focus on when you reduce the
amount of time.
Chairman Akaka. Mr. Rowan?
Mr. Rowan. I would concur with Mr. Surratt's statement on a
lot of that, particularly with the issue of the time it takes
when a case is deemed denied and then it has to go to the Board
of Veterans' Appeals. There is a real problem of getting it out
of the regional office, even down into the Board of Veterans'
Appeals to even start their process, which takes a significant
amount of time.
Clearly, I also agree that a lot of the time is lost in
moving things around, and one of the other things that concerns
me is this idea of putting everything in one basket for, as
already occurs now. I happen to do a lot of my work, when I was
doing it, out of the Manhattan VA Regional Office, which,
unfortunately, was one of those regional offices where the
staff disappeared. I mean, the place is like a ghost town
because of retirements, and they never got backfilled and
replaced. And, therefore, they said, well, gee, we do not have
enough staff, so we have got to outsource all your claims. So
they started sending them all over the place, and they end up
in different parts of the country.
The problem with that is, it takes time to move all of
these cases out of New York, literally take that file and mail
it out to somebody else, and when they have adjudicated, mail
it back. We never get to talk to that adjudicator sitting out
in Togus or wherever they are. And that is a problem because
there is no interface between the rater making the decision and
building up the case and the VSO who is working on it. And that
is a problem. So, I mean, I am really concerned about that.
The 120 days is more than reasonable if they ever got
anywhere near that. The reality is that is not even close. Even
the duty to assist letter that we see that goes out initially
does not get to the veteran half the time in 30 days, and then
they are supposed to have ``X'' amount of days when they start
the clock. So there is a real backlog problem.
Again, I cannot state enough, they have got to get back to
the problem that they are not electronic, that these files sit
on paper. I will tell you, I would not want to be a rater at
the VA. I would not want to be somebody who has to work in that
system. If you go to any of these VA regional offices and you
look at these people and look at their desks, and then you look
at the two desks that are empty next to them--because those
raters retired--which are filled up with all of the case files
that they are actually working on, then you can see immediately
visually why there is a problem. And it is just too obvious.
Mr. Surratt. Mr. Chairman, I have some of those exact
times, if you would permit me to give them to you, on the time
that an appeal sits. Again, once a veteran files a Notice of
Disagreement, VA responds by sending the veteran a statement of
the case, and the statement of the case outlines the facts and
the law that were considered in how they arrived at the
decision. And for the appeal to go forward, the veteran has to
perfect that appeal by filing a substantive appeal or a Form 9.
Now, they have 60 days administratively to do that. I mean,
actually, they have a year, but VA deactivates the appeal if
they do not respond in 60 days. On average, veterans respond in
41 days.
Once that Form 9 is in the file, the appeal is
theoretically perfected and it is ready for a BVA decision. But
the average time nationally in 2006 between the time the appeal
was perfected and the time it was received at the Board of
Veterans' Appeals was 489 days.
So if you want to find where the time is, it is in things
like that. I do not know why appeals sit in the regional
offices for, you know, 489 days between the time they are
theoretically ready for a decision, but those are the areas
that need to be looked at.
Chairman Akaka. All right. Thank you for that.
Mr. Rowan and Mr. Surratt, you heard Admiral Cooper's
response to my question about prioritization of Global War on
Terror claims. In your opinion, are enough measures being taken
to ensure that other veterans with claims in the system are not
adversely affected by that prioritization system of Global War
on Terror claims?
Mr. Rowan. I am not sure that that is happening. I think,
in fact, something has got to happen somewhere. I mean, if you
squeeze the balloon on one end, it has got to pop out somewhere
else.
I understand they are trying to do it, and maybe if they
do, in fact, put all the cases in one or two regional offices
and create the Tiger Teams they are talking about, maybe they
can speed up the process and, therefore, not totally or
completely adversely affect everybody else's claims. We had
seen this earlier on when they had these over 70-years-of-age
cases. And, again, it was quite obvious, they wanted to get the
claim done before the veteran died, unfortunately. But even
dealing with Vietnam veterans, they are in that situation on
many cases, and there are ways you can try to prioritize a case
within the VA. If I have got somebody who is literally dying
from cancer, I can go there to get the VA regional office to
speed that claim up. You know, and you have got all of these
kinds of priorities.
But I will get back to the more basic one, which is when
the veterans file a claim and they are in that situation that
one of the Senators had talked about earlier, and you are
sitting there waiting to get your claim adjudicated to pay your
rent because you cannot work anymore because of your physical
disabilities which you believe is a service-connected illness,
you are hung out to dry. That case just gets pushed further and
further back because you are giving priority over here--and I
am not saying we should not help these veterans--in making sure
that system works. And maybe they ought to be the test case for
creating an electronic system, and maybe we should say, fine,
we are going to take all the OIF cases and make them electronic
and get that--I mean, you can buy a computer system off the
shelf. DOD has a million computer systems. I cannot believe we
cannot create one in 30 days to make the system work. High-
speed scanners are easily available. All of these things are
existing and right now we can walk outside and I can give you
20 vendors who will sell all that stuff to the VA tomorrow.
Somebody has got to make that decision to throw the switch
to turn it into an electronic system, and I would feel better
if, in fact, they were going to give the OIF priority cases
that kind of system. And if the DOD has all this electronic
records, which I believe they already have on all these
veterans coming out of the military today, because they are
smarter and they are dealing with all this computer stuff and
not with what we did in my day and age, then I think that
should be a good test case. Maybe that should be the cases that
get set aside, and maybe that is how they try to prioritize it
and at the same time affect radically how the whole
adjudication process occurs. And maybe they will learn some
lessons in the process.
Chairman Akaka. Mr. Surratt?
Mr. Surratt. Well, Mr. Chairman, as Mr. Rowan had said,
anytime you send someone to the front of the line, you send
someone else more to the back of the line, and that delays
their case. I think priorities of this type may be necessary,
but they are a reactive, short-time solution. If the system was
working efficiently, you would not need priorities. Everyone
would get their claims decided timely.
Let me say something about the BDD thing along those lines.
To qualify for that, you have to have a certain number of days
left in the military, and you have to have a known discharge
date. So that applies to veterans who are being discharged
regularly who may have disabilities. But all these seriously
disabled veterans in these medical hold companies do not have
entitlement to that because they do not have a known discharge
date. And sometimes their records are not there yet and so
forth. So the more severely injured veterans do not get the
benefit of the BDD, which is intended to speed up their claims.
So I think if the military and VA could get together and
somehow work that out to where these veterans that we hear
about over in Walter Reed and in Madigan in Seattle and places
like that, or in the medical hold companies, I think they
should find a way to get them under the BDD process or a
similar process, too, because if anyone is deserving of
expedited service, they are.
But getting back to the priorities, you give one veteran a
priority, someone else suffers, and that is not an ideal
situation.
Chairman Akaka. Mr. Rowan?
Mr. Rowan. Senator, can I just add something? The other
process is that a lot of the people in the DOD in the military
hospital system do not want to get out of that system because
they do not want to go to the VA system because they hear the
horror stories of the people who are getting out. So a lot of
times it is the soldier, the military person who is saying, ``I
want to stay here because I am getting good service here. If I
go out to the VA, God knows what is going to happen to me. And
they know they are not going to get their claim adjudicated
right away upon their getting out. Meanwhile, they are sitting
there getting their military pay while they are sitting in the
hospital. I have seen that, case after case on that, where I
finally get the person discharged and then I have got to start
the VA process instead of having the whole thing done. I mean,
they could adjudicate between--no matter what date the person
is getting out, if they have somebody who has had an
amputation, they know what it is. I mean, let's be honest here.
So we can take care of a lot of that.
Chairman Akaka. Well, thank you.
Mr. Bertoni, VA obtains records from the U.S. Army and
Joint Services Records Research Center for some post-traumatic
stress disorder claims. As GAO has indicated, lag time affects
VA's processing timeliness and decisional accuracy. Can you say
something on this issue? How do we know that information that
VA receives from these groups is accurate?
Mr. Bertoni. That is a two-part question. In terms of the
PTSD you are referencing to, PTSD claims, I think, in general,
getting records from these sources is difficult because medical
records and service records are oftentimes spread out across
various areas and oftentimes are not where they are supposed to
be or they are lost. In our report, we were concerned, we
focused on the PTSD claims, which do take in excess of a year.
Generally, if a PTSD claim person comes in and can prove
that they were in combat, were a prisoner of war, their
allegation of the stressor event or their statement of the
stressor event, the description, is sufficient pretty much to
qualify them for a benefit. But if they cannot prove that this
person was in combat or was a prisoner of war, then it is
incumbent upon the regional office to go to the VBA units
located in the National Records Center to have to find that
information. And if you are lucky enough to have been in the
Marine Corps, there is an electronic database that can be
searched fairly--it is accessible. It can be searched quickly.
And turnaround time for those cases can be as little as 1 day.
If you are in any of the other services, it essentially
requires a manual slog through paper files, and it can take in
excess of up to 1 year.
So that was an issue. We did find one database that--it was
an unclassified database--one of the regional offices in, I
believe, the Chicago area had put together and was using to do
their own search prior to making the request to the Records
Center, and it was effective. They were able to get the
information they needed in 2 to 3 weeks. And they had lent that
same database to other regional offices for their searches
also. So we had recommended that perhaps VA should think about
a comparable system that could be used nationally prior to
having to make that request to the Records Center.
In terms of accuracy, our concern was that there was no
quality assurance check of the work of the researchers that
were going out to gather the information to bring to the RO to
make the determination. The information was getting to the RO
for the most part. For less than four cases there was error.
But we did not know whether that was all the evidence that
should have been gathered, the complete history. And there was
nobody going in on VA's side to go behind, from a quality
assurance standpoint, to do some sampling to make sure that
these researchers were not missing key documents that could
either substantiate or refute the claim. And we, in fact, cite
an example in our report where that was the case for a Vietnam
veteran.
Chairman Akaka. Mr. Rowan?
Mr. Rowan. Yes, sir. Just a couple of things on that.
One of the things that needs to be understood, PTSD claims
can have presumptions, just like the Agent Orange stuff. If you
have a particular award or decoration, if you have a particular
combat device such as a CIB or a Combat Medical Badge or a
Combat Action Ribbon in the Marine Corps and Navy--
unfortunately, us guys in the Air Force, we do not have
anything like that. Those are automatics. Again, the stressor
is presumed. If you have got a Purple Heart or you were a POW
and they have got it on your record, we do not have to go into
the big song and dance. It is presumed you went through stress.
The problem is with the 70, 80 percent of everybody else,
what do I do with the Marine air wing guy who got sent out on
missions once a month because he was a Marine and they decided
he had a gun and he ought to go out and use it once in a while
in Da Nang, for example? Or the truck driver who had to go
through places where he was getting shot at and bombed and
everything else on a regular basis?
The military changed that, if you noticed, with this new
Combat Action Badge to try to expand identifying those people
who have been submitted to combat stressors. And I would be
curious to see if the Combat Action Badge gets added to the
list. I do not know if it has yet. I do not think it has. But
it would be interesting to see if it does.
One of the things that does concern me, however, with the
new folks in particular with regard to PTSD, we are seeing and
hearing of cases where the Department of Defense and the Army
and the Marines and wherever are identifying people with
personality disorder and not PTSD. And they say, ``Well, you
have got personality disorder. You are not PTSD, and we do not
owe you anything, so go away.'' And I am concerned about that
because that is the old shell game that we have seen going on
in earlier days. And so I hope that the Senator might be able
to take a look at that sometime.
Chairman Akaka. Mr. Bertoni, to follow up on your
testimony, you noted VA's regional office claims processing
structure may not promote efficient operations. You noted that.
In your view, what opportunities is VA missing to improve
productivity, accuracy, and consistency by maintaining 57
regional offices?
Mr. Bertoni. I think it is our view that VA or GAO really
will not know what they are missing until a proper analysis is
done to get at those issues, and that is why we have
recommended that VA take a strategic look at its organizational
structure to see if it has the people, processes, and
technology in place to essentially be the most effective
operating unit that it can be.
What do we know? I think, as cited today, where VA has
taken on the Tiger Teams, the special initiative to go after
problematic workloads in the short term, I think they have
claimed that there are some positives in terms of productivity,
accuracy, the establishment of expertise among staff that
constantly work a particular claim, as well as consistency in
decisions in terms of entitlement, the dollar amounts
allocated, and the ratings percentages.
So if you look at it that way, when you do consolidate,
when you do restructure and re-engineer processes, these are
some small tactical areas where there have been, I think, some
positives.
We also know that where they have not made some really real
structural changes in their 57 regional offices, we have the
opposite. We have productivity issues. We have inconsistency of
decisions and accuracy rate problems. We have variability
across the agency.
So we see that as potentially problematic, and our
recommendation is that, again, VA needs to really take a more
strategic step back, not just a tactical step back and just
sort of fight fires, but step back and look if they have the
people, processes, and technology in place and how they might
reconfigure their organizational structure to be more
effective.
We do not have the answer. We just think somebody needs to
look.
Chairman Akaka. Well, thank you very much for that.
Mr. Surratt. Mr. Chairman, may I comment on that?
Chairman Akaka. There are other questions that I will
submit for the record to you, and I want to thank you for your
responses. This will be helpful to me.
But let me conclude this hearing by giving you an
opportunity to briefly make any other comments before we
adjourn here and ask any of you three whether you want to make
any final comments.
Mr. Surratt. I do, Mr. Chairman. I would like to talk about
the question you just asked the representative from GAO.
Regarding consolidation, this is the DAV's view: If you are
talking about an education claim which does not involve
judgment, it is just looking at the person's qualifying service
and so forth, or if you are looking at the aspect of pension
involving calculations of income, or if you are looking at loan
guarantee, those kinds of things can be centralized because
there is not much of a need for the veteran to interact with
the decisionmaker.
But one of the good things that VA did as a part of its
business process re-engineering effort was to establish
decision review officers, and this was intended where the
veteran could come in and actually talk to a person who would
make the decision. And that interaction, face-to-face
interaction, between the veteran and the decisionmaker proved
to be very good. So if you take the mainstream disability cases
and consolidate them, you lose that ability to have the veteran
come in and personally appear before someone that makes a
decision in his area.
In addition to that, if you look at offices like New York
and St. Pete and some of those, bigger is not better. So I
would caution the Committee that while consolidation is good in
some places and even as short-term measures, Tiger Teams are
good--the Tiger Teams, again, are an indication that the system
is failing to operate in a routine way. That is a reactive
measure. So while that is good, it is necessary, it is not a
long-term solution.
I would like to say something about Senator Craig's
recommendations that we look at the Veterans' Claims
Adjudication Commission recommendations. When that committee
reported in 1996 or 1997, virtually all the major
recommendations were rejected by the VA Secretary at that time.
There was a hearing in the House, at least, and none of the
major recommendations like lump sums and putting time limits on
claims and other things, none of those things were accepted.
They were, in effect, rejected because they all had the same
method of solving VA's problems. They would reduce veterans'
rights to solve VA's problems. And let me tell you that DAV is
opposed to putting time limits on claims, doing anything that
seeks to accommodate any inefficiency or lack of capacity in
the VA by taking rights away from veterans. And almost all
those recommendations did that, and that is why they never got
off the ground. And I would hope that we do not spend too much
time pulling that report out of the cobwebs and revisiting
those bad ideas and attempting to reinvent that broken wheel.
Thank you.
Chairman Akaka. Thank you very much.
Mr. Rowan?
Mr. Rowan. Senator, just a couple of things that I did not
get a chance to cover in the early part. One of the big
problems we are concerned about is the phone lines for the
people calling in and trying to get information. There is a lot
of misinformation that has gone on in there, and that has been
reported out by a lot of folks. Again, one of the other
problems is the system that they have for tracking the claims,
where that piece of paper is, is often not kept up-to-date by
the various people who handle that piece of paper, therefore
making it difficult for the veterans to find out where they
are.
And we really believe that we need to see--I keep hearing
about this nonadversarial relationship, but it sure does not
feel that way, at least from my side of it. And I think that
the whole system could do with a lot more interaction between
the raters and the VSO service reps of the various
organizations. As the claim goes on, if somebody has got a
question, they ought to be able to really come to us, and they
do not always do that.
There was also something that I saw in Admiral Cooper's
statement, I believe it was, about how the raters should be
able to identify additional stuff and add it on to it. I have
never seen that. I have never seen somebody get something that
they did not ask for. And where we get into some of this in
particular, and I know in my case as a diabetic, with all of
the secondary conditions, nobody says, ``Oh, by the way, we
noticed that you have high blood pressure so we will throw you
another 10 percent on that one.'' No way. I have never seen a
rater do that--ever. Maybe some of my colleagues have a
different aspect to that or a different experience of that, but
the idea that a rater will give somebody extra, something that
they find because they found it in the system and they know
they are entitled to it, I would be shocked to hear of that
happening.
Chairman Akaka. Thank you.
Mr. Bertoni?
Mr. Bertoni. Thank you, Mr. Chairman. I would just like to
echo one thing relative to productivity. It is our position
that VA needs to continually strive to increase productivity
and to really leverage IT resources to get there. We have a
situation in the Social Security Administration where I spent
15 years looking at that disability program where they are
entirely paperless. They are electronic case files. They are
paperless. They can shift massive workloads to areas across the
country to expedite processing. They can pull up multiple
screens and just sift through a few documents that would be 10
inches--10 feet deep in some records--and be able to develop
claims. So I think managing the resources that VA has,
leveraging their resources through IT investment is somewhere
they need to really look.
Second, I think the issue of inconsistency needs to be
addressed. We have recommended that they look at their
decisionmaking processes at all levels and try to determine
what level of variability is acceptable, and where it is not
deemed acceptable, to really focus in on making those fixes.
And they have made some efforts. They have started. I think, in
2005, they selected three impairments that were subject to
inconsistency: knee pain, PTSD, and hearing loss. And in that
example, they took ten subject matter experts and reviewed
1,750 claims to try to get at some of the root causes of
inconsistency. I think they need to do that across their
impairments to get a good handle on where their vulnerabilities
are, and they will need to target their efforts in that area.
Chairman Akaka. Well, I thank you very much, all of you,
for your responses. It will be helpful to us.
This hearing of the Senate Committee on Veterans' Affairs
is adjourned.
[Whereupon, at 12 p.m., the Committee was adjourned.]