[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
QUALITY VS. QUANTITY: EXAMINING THE
VETERANS BENEFITS ADMINISTRATION'S
EMPLOYEE WORK CREDIT AND
MANAGEMENT SYSTEMS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
MAY 6, 2010
__________
Serial No. 111-77
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
______
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
JOHN J. HALL, New York, Chairman
DEBORAH L. HALVORSON, Illinois DOUG LAMBORN, Colorado, Ranking
JOE DONNELLY, Indiana JEFF MILLER, Florida
CIRO D. RODRIGUEZ, Texas BRIAN P. BILBRAY, California
ANN KIRKPATRICK, Arizona
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
May 6, 2010
Page
Quality vs. Quantity: Examining the Veterans Benefits
Administration's
Employee Work Credit and Management Systems.................... 1
OPENING STATEMENTS
Chairman John J. Hall............................................ 1
Prepared statement of Chairman Hall.......................... 30
Hon. Doug Lamborn, Ranking Republican Member..................... 3
Prepared statement of Congressman Lamborn.................... 31
WITNESSES
U.S. Department of Veterans Affairs, Diana M. Rubens, Associate
Deputy Under Secretary for Field Operations, Veterans Benefits
Administration................................................. 21
Prepared statement of Ms. Rubens............................. 53
______
American Federation of Government Employees (AFL-CIO), and AFGE
National Veterans Affairs Council, Jimmy F. Sims, Jr., Shop
Steward, Local 1738, and Rating Veterans Service
Representative, Winston-Salem, NC, Regional Office, Veterans
Benefits Administration........................................ 14
Prepared statement of Mr. Sims............................... 51
American Legion, Ian C. de Planque, Deputy Director, Veterans
Affairs and Rehabilitation Commission.......................... 12
Prepared statement of Mr. de Planque......................... 48
CNA, Institute for Public Research, Eric Christensen, Managing
Director of Health Research Policy............................. 3
Prepared statement of Mr. Christensen........................ 31
Disabled American Veterans, John L. Wilson, Assistant National
Legislative Director........................................... 10
Prepared statement of Mr. Wilson............................. 45
National Organization of Veterans' Advocates, Inc., Richard Paul
Cohen, Executive Director...................................... 7
Prepared statement of Mr. Cohen.............................. 38
National Veterans Legal Services Program, Ronald B. Abrams, Joint
Executive Director............................................. 8
Prepared statement of Mr. Abrams............................. 40
Veterans of Foreign Wars of the United States, James D. Wear,
Assistant Director, National Veterans Service.................. 9
Prepared statement of Mr. Wear............................... 43
QUALITY VS. QUANTITY: EXAMINING THE
VETERANS BENEFITS ADMINISTRATION'S
EMPLOYEE WORK CREDIT AND
MANAGEMENT SYSTEMS
----------
THURSDAY, MAY 6, 2010
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Disability Assistance and Memorial
Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:00 p.m., in
Room 334, Cannon House Office Building, Hon. John J. Hall
[Chairman of the Subcommittee] presiding.
Present: Representatives Hall, Donnelly, and Lamborn.
OPENING STATEMENT OF CHAIRMAN HALL
Mr. Hall. Good afternoon. The House Committee on Veterans'
Affairs, Subcommittee on Disability Assistance and Memorial
Affairs, will come to order for our hearing.
Quality vs. Quantity: Examining the Veterans Benefits
Administration's (VBA's) Employee Work Credit and Management
Systems is the theme today, and I would start by asking us all
to rise for the pledge of allegiance. Flags are at both ends of
the room.
[Pledge of Allegiance.]
Thank you, and welcome to today's hearing that is entitled,
``Quality vs. Quantity: Examining the Veterans Benefits
Administration's Work Credit and Management Systems.''
The purpose is to examine how VBA's employee work credit
system and its claims processing improvement work management
system model may contribute to diminished quality,
accountability, and accuracy in compensation and pension claims
processing.
Today's hearing continues this Subcommittee's efforts to
analyze various elements of the compensation and pension claims
process over the 111th Congress and marks our fifth oversight
examination this year focused on ensuring that our veterans and
survivors properly receive their benefits. It is our collective
quest to vanquish VBA's backlog of claims and appeals, which
currently exceeds 1 million.
We also intended for today's hearing to provide an
opportunity to examine a Congressionally mandated report on the
VBA's work and management systems outlined in legislation that
was developed by me and other Members of this Committee during
the 110th Congress, the Veterans Disability Benefits Claims
Modernization Act of 2008, H.R. 5892, codified in Public Law
110-389. The goal of this legislation, among other things, was
to provide VBA with a valuable road map to assess and improve
its work credit and management systems to produce better claims
outcomes for our veterans.
The deadline for this report was October 31, 2009, and I
note that we have yet to receive it. However, the VA has
authorized an independent research contractor that was retained
to complete this report, the Center for Naval Analysis (CNA),
to testify before us today concerning a summary of the report's
findings and recommendations, the Cliff Notes version of the
report, I guess. The U.S. Department of Veterans Affairs (VA)
advised the Subcommittee that the report is still under review
by the agency and Office of Management and Budget (OMB) and
should be submitted to Congress soon.
We look forward to hearing today when the report will be
ready and submitted to Congress and to getting a better
understanding of why it has not yet been delivered.
Since 2007, the VBA has added over 7,100 claims processing
personnel; and Congress has funded these requests. Yet the
backlog still climbs. This is not to say that adding additional
workforce has not been beneficial. Had Congress not provided
these new claims processors, the backlog might be much worse
than it is today, given the exponential growth in claims
receipts.
As the VA itself acknowledged during Chairman Filner's
Claims Roundtable in March, this is a sign of a broken system.
The mounting claims backlog is a symptom that cannot be
addressed until the VA refocuses itself on adjudicating claims
correctly the first time. We need to continue to look at the
system with fresh eyes and determine how a new outlook can help
VA fix its claims processing system and get the backlog under
control.
In convening today's hearing, the Subcommittee seeks to
further explore how the VBA work credit incentives and the
flawed Claims Process Improvement (CPI) Model might be
contributing to delays and errors in the claims process. It is
my hope that we will--in continuing to examine this issue--be
able to help veterans secure the benefits they deserve and
prevent them from suffering further injury as a result of
delays in receiving disability benefits.
That is why I want to revisit the issue of partial,
provisional, and temporary ratings. I believe that if the VA
increases the use of this authority and also awards a credit to
claims processing personnel who use it, it will go a long way
in making sure that more veterans can begin to receive their
benefits more promptly. I would like the VA to address this
issue when it testifies.
Today, we will also hear from veterans service
organizations (VSOs) and advocacy groups who will explain their
vision for how the VA should address this problem. From them, I
know we can get a better understanding of the underlying issues
that led to such an unmanageable backlog at VBA, as well as if
they believe that the efforts of the VA are in the right
direction regarding this issue. Specifically, I would like to
know if the VSOs and advocacy groups agree with VBA's assertion
that it emphasizes quality on a par with quantity and
timeliness.
I look forward to your testimony and insightful comments
and questions from my colleagues, and I would recognize Ranking
Member Lamborn for his opening statement.
[The prepared statement of Chairman Hall appears on p. 30.]
OPENING STATEMENT OF HON. DOUG LAMBORN
Mr. Lamborn. Thank you, Mr. Chairman, and I look forward
also to this afternoon's hearing on VA's work credit system.
The purpose of this discussion is to ascertain whether
proper performance measures are in place to effectively gauge
both efficiency and accuracy of work. A system that rewards
work credits based on production alone undermines quality; and,
as we all know, poor quality work has ramifications throughout
the entire system that has contributed to the backlog of
claims. At the same time, there is also clearly a need for VA
to maintain a high level of efficiency so that veterans can be
receiving compensation in a timely manner.
Where does the proper balance lie? True quality means being
effective and efficient. The key to achieving this balance lies
in how employees are rewarded for the work they accomplish. For
too long, it appears that VA has placed too high an incentive
on production, but it is simply counterproductive to strive for
high numbers if the work has to be revisited at a later time.
Yet, it would be equally detrimental to veterans if there was
an overemphasis on quality and the average handle time was off
the charts.
This Subcommittee passed legislation during the past
session to obtain a study of the effectiveness of the VA's
employee work credit and work management system. From this, we
hope VA will be able to develop a more effective means of
improving its claims processing performance. I look forward to
working with my colleagues and Department officials to delve
into this issue and hopefully identify how the work credit
system can help incentivize the proper balance between quality
and quantity.
I want to thank the witnesses in advance for their
participation and their testimony, and I look forward to our
discussion today.
Mr. Chairman, I yield back.
[The prepared statement of Congressman Lamborn appears on
p. 31.]
Mr. Hall. We just had a vote call, but I would like to move
ahead with our first witness, and then we will have to break so
we can go across the street and vote and ask the rest of you to
be patient, as you always are.
So we will first welcome Eric Christensen on our first
panel, the Managing Director, Institute for Public Research,
CNA.
Your full statement is entered in the record, sir and you
are now recognized.
STATEMENT OF ERIC CHRISTENSEN, MANAGING DIRECTOR OF HEALTH
RESEARCH POLICY, INSTITUTE FOR PUBLIC RESEARCH, CNA
Mr. Christensen. Thank you, Mr. Chairman, distinguished
Members. I appreciate the opportunity to testify before you
today on the subject of VBA's work credit and work management
systems.
As you said, I am Eric Christensen, Managing Director of
Health Research and Policy at CNA. CNA is a non-profit firm
that provides independent objective analysis to various
government agencies.
CNA conducted its analysis of the work credit and work
measurement systems between March and September of 2009. We
interviewed over 100 VBA employees at six regional offices
(ROs) to understand the issues, complexities, and incentives
associated with these systems. We note that VBA works in a
challenging environment. The number of compensation claims
submitted each year increased by 53 percent between fiscal
years 1999 and 2008. At the same time, the complexity of claims
has also increased.
There are three principal concerns about the current
employee work credit system: one, that it emphasizes quantity
over quality; two, that production standards are not based on a
careful analysis of the task performed; and, three, that work
credits and production standards do not reflect changes in
claim complexity and additional duties imposed by legislation.
Our study confirmed that employees perceive that quantity
is emphasized over quality, as well as confirmed the other two
concerns.
To address these concerns, we recommended that VBA redefine
the work credits so that work credits account for claim
characteristics that are correlated with the amount of work
required. For example, accounting for the number of issues and
types of medical conditions would likely be important to
accurately reflect the work credits on a claim.
Further, we recommended that VA consider two options or
frameworks when redefining work credits. The first is to give
work credits for only the following broad groups: one,
initiating development; two, making a claim ready to rate;
three, deciding an award; and, four, authorizing the award.
This was the recommendation of a VA work group. At the time of
our report, VA was preparing to pilot test this approach at
multiple sites.
The second option is to base work credits on a
comprehensive, detailed list of all individual activities that
employees perform.
As for quality, we recommended that VA conduct more quality
reviews to better communicate quality as a priority. Similarly,
we recommended that, on internal quality reviews, VA consider
deviations from official procedures for claiming work credits
as errors rather than as comments. Further, we recommended that
there would be work credit deductions for actions with errors.
Turning to VBA's work management system, the concern is
that quality and accountability are lacking, because many
different people are involved in processing each claim under
the Claims Process Improvement, or CPI, Model.
Note that the CPI Model is not VBA's first effort to manage
claims processing by dividing it into separate stages and
passing a claim through a series of people. In the 1990s, VBA
used a similar model called the unit model. In the late 1990s,
there was an effort to address these challenges of the unit
model. These challenges were lack of individual accountability
and an emphasis on quantity over quality. The solution was a
case management model in which each case was handled by one
veterans service representative (VSR) and one rater. VBA used
this model until it adopted the CPI model in response to
concerns about problems with timeliness.
At the time of our report, VBA was conducting a pilot study
in the Little Rock regional office. The key element to this
pilot is processing claims that contain predetermination,
rating, and post-determination functions while maintaining the
current specialization of VSRs under the CPI model. This model
appears to have the potential to improve quality compared to
the CPI model, especially if it creates a greater sense of
accountability. Consequently, we recommended that VA waits to
see the results of this pilot before investigating other
alternatives to the CPI model.
Thank you for allowing me to testify. I would be happy to
answer any questions you may have.
[The prepared statement of Mr. Christensen appears on p.
31.]
Mr. Hall. Thank you, Mr. Christensen.
We will just ask you a couple of questions before we break
for votes; and if we have any more, we will submit them to you
in writing.
But in surveying stakeholders concerning the VBA's employee
work credit system, the central issues, as you noted, indicate
that you are able to determine, first, that the system
emphasizes quantity over quality, that production standards are
not based on a careful analysis of the tasks performed, and
that work credits and production standards do not reflect the
changes in complexity of claims and in Congressional mandates.
What would you recommend to address these issues?
Mr. Christensen. As I mentioned, what we recommend--the
issue is there are very broad categories with which credits are
given. So, for example, a claim with zero to seven issues would
receive the same work credits if it was one issue or seven.
There is a difference in work credits if the claim has eight
issues or more compared to something that has less than that.
Those are relatively broad categories. We would recommend that
narrower variations be given in work credits.
We also recommend that work credits be contingent upon the
type of medical condition. There is some variation of work
credits, for example, if a veteran has post-traumatic stress
disorder (PTSD), but, otherwise, there is really no recognition
of type of medical condition. You speak with people at the VA
and the people who rate the claims, obviously, a hearing case
is much simpler and probably over credited compared to some
other types of claims such as one with traumatic brain injury
(TBI). So we think that considering those things in the work
credits would be important.
As I mentioned a couple of options, there are two really
kind of philosophical approaches you can take for credits. One
is giving a credit for each individual action that raters
perform, and the other is basing credits more on broad
categories of moving a claim past key milestones in the
process. It is kind of a different philosophical approach to do
so. There are advantages and disadvantages to each of those,
but those are things that we recommend in terms of production.
The other recommendations of quality are really to create
signals to rating personnel that quality is important.
Mr. Hall. Thank you.
And can you give us any insight into why the VA has been
unable to release the study which was done by CNA, which I
believe you said was completed in September?
Mr. Christensen. We completed it in September and delivered
it to VBA per our contract. I cannot speak for VA in terms of
why they have not provided it to you.
Mr. Hall. Mr. Christensen, the last question I have is,
there are two, as you said, seemingly opposite philosophies
that may be able to be followed at the same time. The question
is, in your opinion, is it possible to provide a partial work
credit or a positive employee evaluation for a claims processor
who begins the flow of compensation dollars to a veteran for an
undisputed part of his or her claim while at the same time
doing what many stakeholders, many veterans groups are
suggesting, which is to not give the complete work credit until
the appeals process or appeals time period has expired and the
final resolution of the claim is done? So that I guess the
question is, can you speed up the front end while at the same
time holding up the back end to make sure that the quality is
there?
Mr. Christensen. That is not something we looked at
specifically. Obviously, you can give work credits however the
system is designed and chooses to do so. But that is not
something we specifically study.
Mr. Hall. Okay. Thank you very much, sir. We will send you
some more questions in writing.
For now, this Subcommittee will recess until after votes;
and I ask the rest of your patience, please.
[Recess.]
Mr. Hall. The Subcommittee on Disability Assistance and
Memorial Affairs will resume our hearing. Thank you all for
your patience.
We welcome our Panel 2: Richard Paul Cohen, Executive
Director of National Organization of Veterans' Advocates
(NOVA), Inc.; Mr. Ronald B. Abrams, Joint Executive Director of
National Veterans Legal Service Programs (NVLSP); James D.
Wear, Assistant Director, National Veterans Service, Veterans
of Foreign Wars of the United States (VFW); John Wilson, the
Assistant National Legislative Director of Disabled American
Veterans (DAV); Ian C. de Planque, Deputy Director, Veterans
Affairs and Rehabilitation Commission, the American Legion; and
Jimmy F. Sims, Jr., Rating Veterans Service Representative
(RVSR) from the Winston Salem Regional Office of the Veteran
Benefits Administration and Shop Steward for Local 1738, on
behalf of the American Federation of Government Employees
(AFGE) .
Gentlemen, thank you so much for waiting and for the
testimony you are going to give and have given.
You know the routine by now. Your full written statement is
already made a part of the record, so you each will have 5
minutes, starting with Mr. Cohen.
STATEMENTS OF RICHARD PAUL COHEN, EXECUTIVE DIRECTOR, NATIONAL
ORGANIZATION OF VETERANS' ADVOCATES, INC.; RONALD B. ABRAMS,
JOINT EXECUTIVE DIRECTOR, NATIONAL VETERANS LEGAL SERVICES
PROGRAM; JAMES D. WEAR, ASSISTANT DIRECTOR, NATIONAL VETERANS
SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES; JOHN L.
WILSON, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED
AMERICAN VETERANS; IAN C. DE PLANQUE, DEPUTY DIRECTOR, VETERANS
AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; AND
JIMMY F. SIMS, JR., RATING VETERANS SERVICE REPRESENTATIVE,
WINSTON-SALEM, NC, REGIONAL OFFICE, VETERANS BENEFITS
ADMINISTRATION, AND SHOP STEWARD, LOCAL 1738, AMERICAN
FEDERATION OF GOVERNMENT EMPLOYEES (AFL-CIO), AND AFGE NATIONAL
VETERANS AFFAIRS COUNCIL
STATEMENT OF RICHARD PAUL COHEN
Mr. Cohen. Thank you, Chairman Hall, for allowing NOVA to
submit its comments regarding the claims allocation process.
It is no secret that we agree with you that the system is
not working well. We have testified in great detail on other
occasions about the backlogs, the errors in the ratings, and
the hamster wheel phenomenon. There is a fundamental problem
not with the individual employees in the trenches who want to
do the right thing. There is a problem with the bureaucracy,
with the organization.
We all know that the VA has problems acting. A case in
point, is Public Law 110-389, which required a report on the
work credit system. The report is not out. The VA has not
issued the required regulations on substitutions in the case
where a veteran dies when the claim is pending. The new Agent
Orange presumption regulations were not put out as proposed
regulations until there was a lawsuit compelling it.
The VA just is ineffective. It reminds us of trying to
correct the course of the Titanic. There seems to be a
disconnect between what the Secretary says, what the management
says, and what is actually going on in the regional offices.
A case in point is the testimony that you will hear later
on from the VA stating that the VA has never emphasized
production over quality. Yet, we had a 2005 report from the
Office of Inspector General (OIG) showing that the work credit
system did emphasize production over quality and inhibited the
ability of VA employees to do quality decision-making. And, in
fact, CNA just testified, and their written testimony says,
that their research indicates that work credit system inhibits
quality.
So what the VA needs is a total course correction in terms
of supervision, and in terms of management.
We have a system where the VA claims to be looking for
quality decision-making, yet they do not know what their actual
error rate is. In their reports, the VA indicates an error rate
around 80 percent. But if you do the math and figure out how
many claims are denied, how many are abandoned, the remainder
that go to the Board of Veterans' Appeals (BVA), and how many
are confirmed by the BVA, you will find out that the error rate
is probably as high as what they say their accuracy is. Their
error rate is about 80 percent if you trace the cases to the
BVA and then to the court. So what the VA needs to do is to
develop a method for analyzing whether they are doing correct
decisions. They need to get it right the first time.
Congress' role is a watchdog. It can't micromanage the VA
but has to encourage them to change the whole system. The pod
approach--where a team takes credit for the end result--is the
way to go, where the credit is not for productivity on an
individual basis but is on reaching the correct decision by the
pod, by the group. That would solve the problem.
The other thing is that the VA is never going to get a
handle on this backlog until they start looking at the crisis
on a triage basis. What they need to do is look at those cases
which are easy grants. The claim by a combat veteran who has a
Purple Heart for benefits based on PTSD needs no further
development. That should be a grant. Don't waste time on it.
There are harder claims with harder medicine, and harder laws.
Those, the VA should spend time on.
They have not been effective in working claims like a true
business, but that is what they need to do. They need to bring
in business experts to help them do this and, as AFGE has said,
true time and motion studies are needed to try to figure out
how to save time on what VA's employees do.
But the bottom line here is NOVA and the veterans who our
members represent are not that interested in work credits. I
know the employees are. I know the VA is. Everyone should be
more interested in quality decision-making from the outset.
Thank you.
[The prepared statement of Mr. Cohen appears on p. 38.]
Mr. Hall. Thank you, Mr. Cohen.
Mr. Abrams.
STATEMENT OF RONALD B. ABRAMS
Mr. Abrams. Thank you, Mr. Chairman.
I would first like to say that when I listened to the
earlier testimony I think that you should be cautioned that it
is not a one-way street. Claims are filed, and people are
represented. And when we get involved in a case, we try to file
the claim as early as we can so a veteran can get the earliest
possible effective date.
But that doesn't mean we are going to let the VA adjudicate
that claim in 30, 90, or even 180 days. Sometimes it takes us,
with all the time that we have to spend on a case, 6 to 8
months to get proper medical opinions; and the VA has to wait
until we get that. So it is just not up to the VA to do things
in a certain time.
The advocates are also going to submit evidence, and we are
going to take our time to get the right evidence. Therefore, if
you have a system that stops the clock for the VA when an
advocate says, look, we are going out and getting several
medical opinions, that would be a good thing. It is not the
VA's fault that we are taking our time, and that would
encourage them to let us do that.
As you know, veterans cannot shop where they are going to
get their VA benefits. They are stuck with the VA. Other people
who are shopping for televisions, for cars, if they don't like
the quality of a certain brand can buy some other brand. Vets
have to go to the VA. And I want to stress that proper
attention by VA managers to protect the fairness of the process
is counterintuitive to them because it affects the statistics
upon which they are evaluated.
For example, control of claims, checking to see where the
claim is, slows managers and workers down. If they have to
review unnecessarily delayed claims, it takes time and energy
to do that. You take people off of production. Development,
even Systematic Technical Accuracy Review (STAR) shows that is
the biggest error; and, as a result of improper development,
claims are just churned. You get on the hamster wheel, and we
have talked about that over and over again.
It takes time to carefully analyze a case and recognize all
the important issues. As you know, the VA has been doing it
wrong for many years. As a result, when a rater gets the case
in the regional office, they have to review the entire file if
they are going to do the right job, and they might have to
correct errors all the way back 30, 40 years ago. This needs to
be acknowledged and built into the work credit system.
There is always tension between quality and quantity, and
the VA has to establish a natural balance. And what we would
like the VA to do is first change its work measurement system
so it reflects the needs of the claimants rather than the needs
of the people working in the VA. Let them adjust to what really
needs to be done correctly.
Second, we should have an independent quality check, one
from outside of VBA. That way you are not going to have
pressure not to find errors, and I think that would help a
great deal.
Thank you very much.
[The prepared statement of Mr. Abrams appears on p. 40.]
Mr. Hall. Thank you, Mr. Abrams.
Mr. Wear.
STATEMENT OF JAMES D. WEAR
Mr. Wear. Chairman Hall and Members of the Subcommittee, on
behalf of the 2.1 million members of the Veterans of Foreign
Wars of the United States and our auxiliaries, I would like to
thank you for the opportunity to be here today to share our
concerns and thoughts regarding VBA's work credit and
management systems.
The VFW's chief concern today is a very real perception
that VA puts more emphasis on the number of claims that are
processed than the accuracy of those claims. This is validated
by the over 1.1 million claims for compensation, pension,
education, and appeals pending, as reported by the VBA in its
weekly Monday Morning Report, as well as many VA OIG reports.
Secretary Shinseki's goal of rating all claims with a 98-
percent accuracy in under 125 days is very laudable, But the
VFW would be ecstatic if the VA could reach the 98-percent
accuracy goal with even the current average wait time of 165
days.
The VFW has developed five immediate actions that we
believe will improve VBA's quality now:
First, the VA management team must focus on changing the
culture in VBA to award quality over production. VBA must
incorporate quality and accountability into its self-imposed
work credit measurement system. VBA must determine which
employees get it right and which employees get it wrong. VBA
must hold every employee and manager accountable. VBA needs to
know who is making the errors in order to train the employees
accordingly. VBA must provide incentives to employees and
managers so that they continuously look for ways to improve
quality. The employees and managers must know that quality is
the most important aspect of their job. VBA's new slogan could
be ``Do It Right the First Time.''
Second, require two signatures on all awards and ratings
prepared by new employees and/or employees with low quality
until sustained improvement is shown. A second signature will
help to ensure a more experienced set of eyes have reviewed the
work of less-experienced employees. Also, it gives managers
more opportunities to train on those errors as soon as they are
discovered.
Third, require employees and managers to prepare partial
rating decisions whenever possible to give the veteran
immediate financial assistance and access to VA medical care.
This will aid veterans and foster good public relations among
veterans. VA must emphasize giving work grade credit for
partial ratings to incentivize employees to make this extra
effort.
Fourth, publicize VSRs and rating VSRs who have
demonstrated consistently outstanding quality. Morale is a
large part of motivating employees to work towards
organizational goals.
Lastly, VA should share with their claimants the average
wait time to process their type of claim in either an e-mail or
in the initial development letter. This would let the veteran
know up front about how long he might have to wait.
The VFW supports a fully integrated system, one that allows
VA to operate in a paperless environment as much as possible.
We urge Congress to use its oversight authority to ensure VA
successfully transforms from a paper-centric to paperless
environment. The VA must enter the 21st Century, which is only
achievable with the support and careful attention of this
Committee.
This concludes my remarks. I would be happy to address any
questions you or your Committee may have.
Thank you.
[The prepared statement of Mr. Wear appears on p. 43.]
Mr. Hall. Thank you.
Mr. Wilson.
STATEMENT OF JOHN L. WILSON
Mr. Wilson. Mr. Chairman, Members of the Subcommittee. I am
pleased to have this opportunity to appear before you on behalf
of the Disabled American Veterans to address the efforts of the
Veterans Benefits Administration to properly balance quality
and quantity in the work credit and work management programs.
Too often, VBA has attempted to manage its ever-increasing
workload emphasizing production to the detriment of accuracy.
DAV is as concerned as the Committee about the large and
growing claims inventory, or backlog, the VBA is managing. The
problem is not the backlog. Nor is it the root cause of the
problem. Rather it is the symptom. It is akin to an individual
having a fever. While one can take an Aspirin to reduce the
fever, the underlying condition, the cause of fever must be
treated. Otherwise, it will return. The patient's condition may
worsen. So, too, it is with the claims backlog and the process.
The underlying condition is a broken claims processing system
that leaves too many veterans waiting too long for rating
decisions that are too often wrong.
Until we address the lack of quality, accuracy, and
consistency--the root cause of the backlog--then no matter how
quickly claims are processed the problem will remain and the
backlog will return.
We, therefore, believe that the best and only approach is
to take one that emphasizes quality at every stage of
production. To achieve this outcome, it is essential that we
examine the system of incentives and accountability for
employees, management, and leadership.
We have heard Secretary Shinseki says that he intends to
break the back of the backlog this year. The only way any such
success will be measured at present is through VBA's Monday
Morning Workload Reports, which contain measures of production,
not accuracy or quality.
Similarly, looking at VBA's dashboard, which provides
current performance statistics for each VA regional office, the
measure's report primarily relates to pending work inventory
and production times, not quality.
With the directive from leadership to break the back of the
backlog, it is not surprising that the RO management focuses
heavily on production, rather than accuracy or quality. Given
leadership's and management's focus on production, it is also
not surprising that VSRs and RVSRs feel tremendous pressure to
meet production goals.
While accuracy has been and remains one of the performance
standards that must be met by employees, we are concerned that
the work credit system creates incentives for them to favor
production over accuracy. Performance standards are the most
important factor in determining the incentives for employees.
If performance standards directly or indirectly reward
production over quality and accuracy, we must expect employees
to work first towards production goals.
The new performance standards have streamlined the measures
of production for VSRs from what had been 63 categories of
rated work activities to five production categories, now called
outputs. Essentially, VSR will receive one output credit for
completing each stage of the work process. We have been told
that the old work credit system created opportunities for
gaming the system, such as delaying requests for routine future
exams in order to get additional work credits later. However,
we are now concerned that the new streamlined system of
measuring only outputs may inadvertently create incentives for
cutting corners, since more complex cases get no more credit
than simple cases.
We know that VBA has increased the accuracy standard for
VSRs, and we certainly agree that accuracy even by the national
STAR measures remains too low. However, it is not clear how
raising the standard in and of itself will result in increased
accuracy.
We also remain concerned about how reliable the employee
reviews will be for measuring quality. We have testified
previously that coach reviews of five cases per month are not
accomplished 100 percent of the time; and, in many cases,
coaches do not have sufficient time to comprehensively review
each case. Consequently, we do not have confidence that
employees performing below or above standard will be
consistently measured.
We are also concerned about these local quality reviews
being different from station to station. We continue to note
that VBA does not have a unified system for aggregating and
analyzing results of both coaches' reviews and STAR reviews to
provide trend analysis for quality control, improvements, and
new training instrument development.
Under the new VSR standards, time limits are established by
each RO based on end-of-year station targets. We recognize
cycle times will vary from station to station but question
whether it is a reasonable expectation to have employees at
different stations being held to different standards for the
same work.
We also have questions about whether cycle times, which
include wait periods and work volume, are the most reasonable
measure for holding VSRs accountable, since it is out of their
control. For example, is the cycle time for average days
awaiting evidence a fair measure, since the admission of
evidence by the claimant is not under the control of the VSR?
VSRs will also now be held accountable for meeting the
training standard. We question whether this should be a
management accountability standard more than an employee
standard, since training is critical to keeping staff informed
of the ever-revolving nature of claims, whether it is new
presumptive service conditions, changes in public law, or
recent court cases.
Given some reports, we have heard from the field about
management pressuring employees to cut back from time for
training to production goals. How is management being held
accountable for training being implemented at the regional
office level?
That concludes my testimony. I would be happy to answer any
questions you may have.
[The prepared statement of Mr. Wilson appears on p. 45.]
Mr. Hall. Thank you very much.
And, Mr. de Planque, you are now recognized.
STATEMENT OF IAN C. DE PLANQUE
Mr. de Planque. Thank you, Mr. Chairman. I appreciate the
opportunity to express the views of the American Legion on the
importance of accuracy in the veterans benefits system.
Before discussing the problem of accuracy in depth, a
little bit of perspective is necessary to illustrate why this
is such an important component of the VA claims adjudication.
According to most optimistic numbers--and these are VA's
public statistics and not those suspected by OIG audit, which
are believed to be much lower--VA is operating at approximately
87 percent accuracy rate, or 13 percent error rate.
This year alone, VA expects to receive and process nearly
200,000 claims solely related to the three new presumptive
Agent Orange conditions. Statistically, we can thus expect that
26,000 of those claims will be processed in error. Twenty-six
thousand veterans will have their claims improperly handled.
That figure represents nearly half of the names on the Vietnam
Wall in Washington, DC.
Every claim is a life affected. Every claim is more than
one life, because veterans have families and loved ones.
Veterans have husbands. They have wives. They have children.
We are told VA will process as many as 1 million claims a
year within the next year or two. One must remember that at
least 1 percent of inaccuracy represents 10,000 veterans'
claims. VA has to do better, clearly.
The inaccuracy of the system contributes to the massive
lack of trust in the VA by the veterans' community. When
veterans cease to trust the system by which their country
returns the promise to them, there must be great concern. VA
has to stop asking the veterans of America to trust them, that
they will be treated properly, and VA is now in a position to
re-earn that trust.
Rather than repeating the number of things that we all have
been saying here, not just in this session but for many, many
years now, I want to touch on something that Mr. Christensen's
report listed this morning. Because we, like you, have not had
been an opportunity to see this report until this time.
One of the things that was stated is there were two surveys
on the perceptions of quality and quantity and considerations
of which is more important and that both surveys had found that
the quantity of claims process was believed to be more
important, and it said something which is very interesting. It
states, this is an important finding, because, even if that
perception is incorrect, at least some employees who have that
perception will probably change the way they process claims in
order to do what they think their supervisors want. Perception
is reality. If VA employees think that numbers are what is
important, that is what they will work to; and they have
nothing to look to that is there to show them that accuracy is
the same thing.
We mentioned the daily reports that VA makes, their Monday
Morning Workload Reports. They list the number of claims and
how long they have been pending. They don't list how accurate
the regional offices are performing. You can find those
statistics, but you really have to start digging for them.
Transparency gets mentioned a lot in Washington right now.
If VA wants to start re-earning that trust from the veteran
community, they need to be a lot more transparent. They need to
put those numbers up and say this is what we are staking our
reputation on. Our reputation is on the accuracy; and if we
can't see that, if the veterans can't see that, if the
employees working in those offices can't see that that is what
VA is putting their priorities to, then they are not going to
believe that that is the case. They are going to believe that
it is still continuing to be driven by the numbers.
There are ways that they can help do that. Obviously, it
takes more time to process a claim effectively; and VA doesn't
want to lose ground with the number of claims that they have
pending right now. Putting an experienced claims examiner at
the beginning of the process to do triage is going to help the
VA if they can have someone who can take these cases and say,
this is ready to rate. This doesn't need as much development.
It was mentioned earlier a hearing loss case doesn't
require near as much work as a TBI case. Put them to the people
who can do the work best.
We have mentioned that hiring all of the VA employees is
going to take a while to show dividends because of the training
times that are involved. Less-experienced employees can handle
simpler claims, such as hearing loss. The other ones can be
directed to other employees who are more competent and more
capable of doing them right.
So if you do better triage at the beginning, if you direct
the cases better, you will be able to do them on time and have
the time you need to do the ones that take more time.
Making time for training. Making training a priority is
also going to show those employees that this is the priority.
We are okay with you setting aside some time from those numbers
to make sure you understand that it is right, and we are going
to take the time to pay attention to what you are doing and get
it right.
There are a number of other solutions, and I would be happy
to answer any more questions on those, but we would like to
state on behalf of the millions of veterans of the American
Legion but also the millions and millions of veterans in
America, VA needs to earn this trust back, and they need to do
that by showing that accuracy is their most important priority.
Thank you.
[The prepared statement of Mr. de Planque appears on p.
48.]
Mr. Hall. Thank you, Mr. de Planque.
Mr. Sims.
STATEMENT OF JIMMY F. SIMS, JR.
Mr. Sims. Thank you, Chairman Hall. Appreciate the
opportunity to testify today on behalf of AFGE and the VA
Council.
In my position as a RVSR and a union steward who has
represented numerous employees, I have seen firsthand the
impact of VBA's work credit and management system. These
systems have placed the VBA on the precipice at a great risk of
falling behind on our mission to provide service to the
veterans and their dependents. The performance standards under
these work management systems established by the VBA do not
provide adequate work credit for many of the critical steps
involved in the claims process.
The new VSR standards that were issued last month provide
no credit for supplemental development such as requesting
additional evidence and have reduced the work credits from over
60 categories to only 5. Denying work credits for critical
tasks will slow down the process and decrease quality.
The standards also force employees to make daily choices
between quality and quantity by including timeliness as a
critical element. Many delays, such as awaiting records from
the U.S. Department of Defense (DoD) or from private
physicians, are outside of the control of the employee and, as
such, employees should not be held accountable for these
delays.
The implementation of the new VSR standards included a
prohibition on variation from the national standards, although
current RVSR standards do not. Local VA ROs may arbitrarily
increase the production standard, which results in disparity
based on geographic location. An RVSR in Seattle may be
required to produce 31 percent more daily work than an RVSR in
Winston Salem. Variations in local standards are taking their
toll on morale and accelerating attrition of senior RVSRs with
valuable experience. I fear that the new RVSR standards being
developed will continue the systemic problem.
Trainees are also being subjected to these unrealistic
standards and working conditions during their initial period of
on-the-job training. The minute they hit the floor, they have
only 90 days to hit the standard. During this training phase,
the receive no time allowance or credit for making corrections
to their work. These VBA production standards result in a waste
of taxpayer dollars through termination of large number of
probationary employees who fail to meet these arbitrary
standards during training.
Under the current work credit management system, employees
find themselves in a catch 22. If they focus on quality of
work, the quantity may fall behind. If they focus on quantity
of work, their quality may fall below. Either situation results
in the risk of demotion or termination.
Because of the inverse relationship of quality and
quantity, many employees find themselves being forced to work
off-the-clock to meet their production and quality standard. By
doing this, they risk disciplinary action for violating VA
directives and Federal wage and hour laws.
One critical element for an effective work credit
management system is a scientific time-motion study that
accurately measures the process. VBA has conducted no more than
a minimal attempt at this. Without an effective analysis of the
process, there can be no improvement.
President Obama's executive order on labor management is
intended to include the employees and their representatives in
development of policies before they are implemented.
Unfortunately, VBA is woefully behind in establishing effective
partnership. Frontline employees and other stakeholder have
ideas to improve the claims process. We are the subject matter
experts and wish management would acknowledge and include us in
the establishment of the policies.
In closing, AFGE urges you to mandate completion of the
scientific study of the claims process for VBA to include
stakeholders in the policy development and to end the local
variations in the RVSR production standards.
Thank you for this time you have allowed me to provide this
insight.
[The prepared statement of Mr. Sims appears on p. 51.]
Mr. Hall. Thank you, Mr. Sims.
I will start with you, sir, Mr. Sims, and ask you if you
could elaborate on your suggestions for VBA so that Rating
Veterans Service Representatives, RVSRs, can more accurately
rate claims at a pace that allows the VA to meet its goals of
timely delivering of benefits to veterans and their families.
Mr. Sims. One of the primary concerns for the RVSRs in the
field is the training that is being provided. Currently,
training is done through a computerized system which is on an
independent basis, which gives no feedback from a subject
matter expert on the issues for which they are training. This
lack of proper training is resulting in a delay in the RVSR
being able to process the claim due to lack of knowledge.
It also is impacting the overall process of meeting the
requirements for the VA. Because as the RVSRs are being slowed
down in their process of rating the claims due to lack of
proper knowledge, it reduces or it increases a backlog of the
claims that we are trying to produce.
Mr. Hall. Can you suggest any specific reforms to the work
credit system that would reward claims processors for spending
sufficient time developing and adjudicating claims? Is there
some way to get around this inverse relationship you talked
about between quality and quantity?
Mr. Sims. The only way that is actually going to be
effective is for the time that is required for each element of
the claims process to be considered in the work crediting
system. Currently, that is not the case.
An RVSR may get a case which contains three issues that may
be incredibly complex and requires hours of review of the
evidence in rendering the decision. But that time frame that is
required to conduct the proper rating is not considered under
the production standards. We are required to maintain a certain
level of productivity without consideration of the amount of
time that is involved in each individual rating. So in order to
adjust the production standards properly, there would have to
be an adequate time management study done, which indicates the
necessary time frame for each individual step in the process.
Mr. Hall. Do you have a comment on I believe it was Mr.
Abrams' suggestion that the clock be stopped at the VA for a
particular claim if the claim is being developed and documents
or medical evidence is being produced by the veteran or
representative of the veteran and that is not within the VA's
control?
Mr. Sims. Unfortunately, currently, the receipt of evidence
from a third party is strictly based on that third party's
willingness to provide the evidence in a timely fashion.
Regulations stipulate that certain providers such as the
Department of Defense, Social Security, those agencies were
required to continue to request that evidence until it is
received. Therefore, the time delay that is associated with
that process is outside the control of the individual RVSR or
VSR. So, currently, the new standards are holding the employee
accountable for that process of which they have no control.
If the VA was to consider a time delay in the processing of
a claim to allow for that third party to develop the evidence
that they wish to submit, then at that point it becomes an
issue of timeliness over the overall process, which Congress
has indicated that needs to be adjusted.
So the current concept of delaying or stopping the clock to
allow for additional evidence to come in may be beneficial on
one aspect for the claimant, but then again it will end up in
greater delays for the claimant and result in a greater delay
in the claims processing overall.
Mr. Hall. Right. And it may be that the VA person who was
trying to get the information from Social Security or from DoD
or whatever will feel less pressure to harass the other branch
of government into coming up with--I understand you are saying
we don't want to make the time longer, but at the same time we
want--I think we are looking for ways to emphasize, as we have
been saying, quality without having the RVSRs or any VA
personnel feel that their evaluation of their work will be more
negative if they take the time to get it right, and that may be
out of their control due to these certain factors.
Mr. Cohen, this question could be for you but also for
everybody else on the panel. Could you briefly state if you
feel the reforms of the claims process that focus primarily on
timeliness and speed of claims will be effective? Do you think
that veterans should be and are willing to accept a slightly
longer adjudication process if it results in a more accurate
claims decision the first time?
Mr. Cohen. I think that veterans and their representatives
would accept a longer time period if it was correct the first
time around.
One of the things, though, that we need to consider is the
biggest delay in processing a claim is in development, is in
getting the exams. If the VA were to make it clear to the
treating physicians who work for the VA that they are permitted
to provide opinions, if they have them, about whether
conditions are service-connected or the degree of disability,
that might eliminate the need for Compensation and Pension
(C&P) exams.
In addition, if 5125 were amended to be mandatory to accept
an adequate exam, one that is adequate for rating purposes,
then, again, additional medical development could be
eliminated.
The biggest part of the time delay is in obtaining these
C&P exams. If we can do anything to shortcut that time, the
total process will be much shorter.
Mr. Hall. Mr. Abrams.
Mr. Abrams. I think any veteran would rather obtain
benefits in 8 months than be promptly denied in 3 months. That
doesn't seem to be worthy of any more discussion. The idea is
to try to get the veteran the benefit as quickly as possible
correctly.
Mr. Hall. General agreement on that, or would anybody else
like to comment?
Mr. Wilson. I would like to say that we--I would like to
see a case take the current 160 days to get done correctly
rather than 90 days to get done quickly but incorrectly. The
excessive amount of churn you will have in the appellate
process is not acceptable to us; and, given the current
situation, moving towards speedier decisions without proper
development is going to lead to just that.
Mr. de Planque. I would just like to add, in terms of
perspective for this, when you have a rush to judgment, if they
are just going to blitz through quickly and get them done in a
short period of time, it has to be appealed. And when we talk
about the backlog and when we talk about veterans waiting years
and years to get their claims, that is not an initial claim. If
a veteran is waiting years and years and years to get their
claim, that is a claim that is on appeal; and it had to be
appealed because there were problems made at the lower level.
The problem is that mistakes at the RO don't take a minute
to correct. They take years to correct. Because it has to go
out to the Board of Veterans' Appeals, sometimes the courts,
because things weren't done right the first time; and that is
why waiting a little bit longer, waiting a couple months more
to get it done right the first time, I don't think any veteran
would argue with that.
Mr. Sims. If I can add the insight from the employees'
perspective on this process.
For myself as a rating specialist, the greatest problem
that I face is inadequate development. Currently, under the
current work management system, the employees are pressured to
get the claims to us on the rating board as quickly as possible
so that we can get a decision out within the 125 days that the
Secretary has stated that we would do.
Unfortunately, oftentimes these claims are not developed
appropriately and evidence is missing, which is intricate to
the rating decision. That is why the appellate process is the
way it is, is because the development process is being rushed.
If the process was slowed down and allowed to be developed
appropriately, the veteran and the claimant on the other end
would get the decision correctly the first time; and that would
alleviate a lot of the appellate process.
Mr. Hall. Thank you, Mr. Sims.
And I would ask starting with you perhaps to comment on the
pod concept and the triage concepts that were mentioned by a
number of our panelists, Mr. Cohen in particular. But what do
you think about those two approaches?
Mr. Sims. I have personally been involved in a pod
situation in which the VSR and the RVSR were paired in a
project that we had at the regional office. It resulted in an
extensive amount of knowledge being transferred between the
RVSR and the VSR on both sides of the equation, and we found
that the quality of our team at that point was 100 percent and
the production was increased by an overall 30 percent. This was
in a decision review process that we conducted.
As for the triage phase, there are a number of claims that
come through that I see on a daily basis that there is no basis
for the additional development to have been conducted. The
decision could have been rendered when the claim was received.
Unfortunately, because there is not an adequate triage system
in place, those decisions are delayed and thus increasing the
overall inventory.
Mr. Hall. Mr. de Planque?
Mr. de Planque. I think with both of those systems--
certainly in a pod system, being able to see the entire
picture, being able to immediately communicate back and forth--
--
Mr. Sims commented not too long ago that development--
inadequate development is one of the biggest problems they
face, the ability to communicate back and forth and say I am
here trying to rate this case but we don't have the development
that we need and this needs to get done at that level. That
level of communications can only help the claims process.
In terms of the triage system, you can't indicate the
importance of that enough. When VA got caught with the
shredding scandal and 10s of thousands of documents were being
shredded, they took it seriously; and they put a GS-12 in every
office whose only job now is to control what documents are
being shredded. That was a way of sending a message that the
document destruction is important.
If they took a high-level employee in every regional office
with the job of making sure this is right, looking at the
accuracy, making sure this is directed to the right place, that
is another way of sending a signal.
We talked about sending signals so the employees have a
perception of what truly is most important: getting the work to
the right places and getting the work done right. That is
another way that they can indicate that.
Mr. Hall. Mr. Wilson.
Mr. Wilson. I think the pods and the pilots that VBA has
implemented are important to consider. There are lessons to be
learned from them. I think we will see that as we continue with
the pilot programs and see what the final reports have from
them.
The triage, putting an experienced person in the beginning
of a particular process to have them as a gatekeeper to make
sure the right decisions are being made by those less-
experienced personnel, and pushing ready-to-rate claims to
raters, is an excellent approach, which is one that should be
adopted as soon as possible at each VA regional office.
Mr. Hall. Mr. Wear?
Mr. Wear. I think the pod system and the triage, I think
those are all good ways to make sure that the claim is complete
as early in the process as possible. We have all talked about
how long it takes--the longer development takes, the more time
it takes to reach a final decision on a case--and the people
don't see it. I think the better we can get the right
information to the VA as quickly as possible and have somebody
look at it is critical.
If we could rearrange who we put where so we could put
maybe a GS-12 or somebody right up front to do triage, I think
that would be really critical to looking at what they have got
and where it needs to go but also working with service
organizations to say, can you get me this or get me that? Or
they can have people call.
All that is going to help get everything focused as early
as possible, and that will lead to a better decision quicker.
Mr. Hall. Mr. Abrams?
Mr. Abrams. We like the pod concept. We don't like what
they have now. Several years ago, we went to one of the
regional offices with the American Legion to do a quality
check, and a friend of mine from my days at the VA called me
aside. He was on the rating board, and he complained forever
about the inadequate development.
Mr. Abrams. He called it widget production. People are
disassociated with the final result when they are isolated and
only have one part of the claim to do. It is much better to do
it the other way.
Mr. Hall. Mr. Cohen, anything to add?
Mr. Cohen. Yes. I just wanted to add something about the
triage. The indication that triage is needed can be seen by the
number of combat veterans who have Purple Hearts or have
significant heavy combat who apply for benefits based on PTSD
and are denied, that either the VA wants more development on
their stressor or doesn't believe the adequacy of their
stressor or doesn't believe that the horrific conditions that
they experienced in combat were sufficient to cause the PTSD.
Those should be no-brainers and should just run right through
the system.
It is appalling that some of these people get denied and
then have to go through the appellate system and may wait a
year and a half to get the benefits that should be so obvious.
Mr. Hall. Thank you.
Mr. Abrams, you said that 60 percent of the claims appealed
to VBA are remanded or overturned, and the most common problem
they report is premature adjudication of claims and lack of
development. Do you think the VA has resorted to using the BVA
and the U.S. Court of Appeals for Veterans Claims as a de facto
quality control process?
Mr. Abrams. Yes. We have been told by VA employees who are
frustrated, that what the VA says is, Let them appeal. Let the
BVA decide this.
And it is a good way to take the case off their backlog,
put it into appellate process, and move it up. This is not the
first time that this has happened.
During the 1970s, when the vets were coming back from the
Vietnam war or Vietnam conflict, I started working at the VA.
And when I walked in, I saw case files piled to the ceiling in
the Philadelphia office, and the managers would run up and down
the aisles yelling, ``Make a final decision.''
You were pressured to take what evidence you had and try to
make a final determination. And most of the time it had to be a
denial, because you didn't have the evidence that would support
a grant.
Mr. Hall. And Mr. de Planque, regarding the Monday Morning
Reports you spoke about, do you believe that the VA could
produce analogous reports to show the accuracy on a weekly
basis of the claims system? Could this lead to an increased
accountability and focus the attention of VA personnel on
quality as a basis for their evaluation and for reforming the
system?
Mr. de Planque. Actually, I think if they are reporting on
quality on a daily basis, it would show that it is important.
And I think that it would help. It is like having your grades
posted on the wall at school. You know, when they have their
workloads posted, this is how many cases they have, this is how
many cases they have pending over this number of days, there
has to be a pressure at that point to move those cases along so
we are not the lowest or we are not the ones who are looking
that way.
If they were having their accuracy ratings posted at the
same time, that is going to create an analogous pressure to--I
want to be in the top of accuracy. I want to be able to point
to our regional office and say we are in the tops in VA in
accuracy.
If you talk to VA employees, as we do when the American
Legion works with NVLSP and does quality review visits, they
want to be proud of the place where they work. And so if you
have something that is publicly posted that this office is
doing this level of quality, there then becomes an incentive to
make sure that you are reaching the top numbers, that you are
achieving, and that you are not falling behind of those levels.
At the same time, it gives the veterans groups, it gives
the veterans themselves, independent of groups, an ability to
look at that and say, All right, this is how I restore my
confidence in VA, because I see where they are going and I see
it is a priority to them because they are posting their numbers
and showing pride in what they are doing.
Mr. Hall. Well, thank you, Mr. de Planque. And thank you
all.
We have more questions for you. I have more questions for
you, but I will submit them in writing so that we can move on
to our next panel. Thank you for your patience and for your
continuing work on behalf of our veterans.
Mr. Hall. And panel two is now excused, and we will have a
changing of the guard and invite our last panel, Diana M.
Rubens, Associate Deputy Under Secretary for Field Operations
at the Veterans Benefits Administration, U.S. Department of
Veterans Affairs, accompanied by Jason McClellan, Director of
the Central Area Office of VBA, U.S. Department of Veterans
Affairs, to join us at the table.
Thank you again for your being here, for your testimony,
and for your patience with the schedule across the street. As
usual, your full written statement is entered in the record.
And, Ms. Rubens, you are now recognized for 5 minutes.
STATEMENT OF DIANA M. RUBENS, ASSOCIATE DEPUTY UNDER SECRETARY
FOR FIELD OPERATIONS, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY JASON McCLELLAN,
DIRECTOR, CENTRAL AREA OFFICE, VETERANS BENEFITS
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
Ms. Rubens. Thank you, Mr. Chairman. Thank you for
providing me the opportunity to appear before you today to
discuss the work credit and management systems study and the
way we think that those things relate to accountability,
accuracy, and compensation and pension claims processing.
We acknowledge the concerns of our stakeholders and our
veterans regarding the current work credit system and perceived
emphasis on quantity over quality. But I want to make it clear
that VBA does not emphasize quantity over quality.
Secretary Shinseki has set a goal for VBA to process
disability claims at a rate sufficient to ensure all veterans
have their response within 125 days. But that is only a
successful effort if we also achieve the goal that he has
established for us of a 98-percent quality rate.
As the Subcommittee is fully aware, Public Law 110-389
required the Secretary to initiate a study of the effectiveness
of VBA's employee work credit and work management systems to
evaluate a more effective means of improving disability claims
processing performance.
I apologize for the late delivery, as we experienced delays
in both the initiation of that study and the completion of that
concurrence process. I do anticipate that it will be delivered
shortly, and am happy to be available for any questions you
have upon your review of that study.
[The Report was received by the Committee.]
The Center for Naval Analyses recommendations closely align
with VBA's current initiatives to better link individuals'
performance with completion of decisions for veterans. VBA has
both long- and short-term strategies underway to reduce the
backlog of claims while improving quality, even as the
complexity and the numbers increase. We continue to hire
aggressively, with the strategy being to make good selections,
provide full training, establish expectations, provide
feedback, and hold ourselves accountable.
As it pertains to quality, I have also asked the area
offices to increase their oversight of regional offices with
quality that doesn't measure up to par. While this is just a
starting point, we need to work all together to raise that to
that 98-percent quality.
We talked a little bit about the new performance standards
that were developed in concert with our national Labor partners
at AFGE, our veterans service representatives, that address
recommendations since made by CNA.
While our local performance standards have always included
a quality element, the new standards further align individual
targets with national targets and require that local reviews
that are being done use that same checklist used by our
national star review team. These new standards give work credit
only for work done that moves the claim to the next stage of
the process, as we feel that aligns most closely with veterans'
desire to actually get a decision in their claim.
We are nearing the 30-day mark of the implementation of
those new standards, and will be working with our labor
partners to review how that implementation has gone in terms of
outcomes as we look at that first 30 days, and then over the
coming months to share that information with them to ensure we
are getting closer to the right standard and measuring the
right things to help us get the job done for veterans.
The CNA study also looked at the current work management
study, referred to as the Claim Process Improvement Model,
which emphasized employee task specialization. VBA has been
engaged for some time in several pilots to evaluate the
alternatives to the CPI model; most notably, the pilot in
Little Rock, Arkansas, which used Lean Six Sigma analysis
techniques. That pilot will complete shortly, and we anticipate
having a final report. Additionally, we have pilots underway in
both our Pittsburgh Regional Office and our Providence Regional
Office to look at the process and technology respectively.
Recognizing that there are many approaches to improve our
process, we have gathered ideas from as many arenas as
possible, to include opportunities such as our Innovation
Initiative competition, engaging in the roundtable held by
Chairman Filner, and in March, VBA leadership met to generate
ideas with the focus on reaching that 125-day processing at a
98-percent quality level. We have also engaged our VSO partners
in a one-day session to get their input directly, and similarly
are working to schedule one with our Labor partners from AFGE
early in June.
VBA does not believe there is going to be one silver bullet
to solve the problems of the backlog, but it will be a
combination of people, process, and technology that will enable
us to meet the Secretary's goal of no claims over 125 days at a
98-percent quality level.
That concludes my statement. I would be happy to answer any
questions you may have.
Mr. Hall. Thank you, Ms. Rubens.
[The prepared statement of Ms. Rubens appears on p. 53.]
Mr. Hall. First of all, could you please explain what has
delayed the transmission of the report outlined in Public Law
110-389. And when you said ``shortly,'' what does that mean?
When will we receive that report?
Ms. Rubens. Yes, sir. I will tell you that this study was
one of 11 required in Public Law 110-389. As we work to get the
studies all engaged, it took us longer than it should have. It
was an inexcusable delay. That was enacted in October. It took
us until March; you heard Mr. Christensen say we engaged them
in March. So that was an inexcusable delay.
As I understand it, and as I followed up in the last couple
of days trying to ascertain just where it is, the concurrence
process, through VBA, VA, and working with OMB, is closer to
the end of that process than at the beginning. And we have
engaged in some ongoing discussions to ensure that everybody
that is looking at it, if you will, outside of VBA, recognizes
that we are late.
Mr. Hall. Well, if the report was done in September, are
you changing the report? Is it being modified? Or are you just
reading it before we get to read it?
Ms. Rubens. I will tell you that I think we were reading it
before you get to read it. And the concurrence process over the
course of October, November, and December was painfully
protracted. It wasn't so much that we are editing or changing,
I think, as making sure that we understand and, unfortunately,
not staying on top of the concurrence process to move it along.
Mr. Hall. Well, I would appreciate receiving it within what
I would consider to be a reasonable time, like the next week. I
see no reason why a report that was paid for by the taxpayers,
that was required by this Congress and by this Committee, and
was completed last September by an outside contractor, should
be sitting somewhere at VA, and for no good reason that I have
been told, other than it being reviewed and concurred upon--
whatever that may mean--has not yet been shared with us. And I
think it is time.
Ms. Rubens. Yes, sir.
Mr. Hall. Concerning that VBA Management System, the CPI
model, today's witnesses have testified that while
specialization of the process improves quality and timeliness
on the one hand, the moving of claims across teams also reduces
quality and timeliness. I know that VA is working on at least
four pilots pertaining to transforming its claims processing
system into a 21st Century entity looking at other business
reorganization efforts in the process.
Could you elaborate on these pilots by explaining how they
fit into the larger mission of greater accountability,
accuracy, and consistency and outcomes?
Ms. Rubens. Yes, sir. The Little Rock pilot that I think
you alluded to and the last panel addressed in terms of the pod
concept, and quite frankly the triage effort, are both things
that are part of that Little Rock pilot. And some of the things
that we have seen have preliminarily shown us that triage
function up front, where you get the claims started in the
right direction with the right folks as quickly as possible,
absolutely will result in a quicker, more timely outcome for
the veteran.
But additionally, that close proximity of the VSRs and the
rating VSRs we found, in fact, does encourage the cooperation,
the learning, the cross-talk in an effort to ensure the VSRs
are requesting the right evidence, the right information that
that rating specialist will need to make that final decision.
As I said, that study concludes shortly. We anticipate to
have a report. We have begun some preliminary discussions
about--and how and what do we do with this on the national
level to ensure that we take the best parts of it to increase
our consistency, our quality, and improve timeliness as well.
The pilot in Pittsburgh is, if you will, a case management
development process where we have begun on a small scale to
engage the veteran on a more personal level early in the
process, so that when we receive a claim we will make a phone
call and talk to that veteran about the contentions, the issues
that they have claimed. Do we understand them? Are we searching
for the right evidence? Are there other pieces of evidence that
might be there that he perhaps forgot or overlooked on his
application?
When we send out that VCA letter that informs the veteran
of what steps we have taken, what steps might help to move that
claim along, it gives us an opportunity, quite frankly, to
better explain what is a very lengthy letter, so that we can
ensure the veteran understands; and that at various points
during the processing of that claim, as we get evidence or have
not received evidence, whether it is from the veteran or
perhaps a third-party private medical care provider, we are
able to apprise the veteran of the progress that we have made,
what help we might use to get that evidence in an effort to
help veterans better understand what we need and move that
claim along, ensuring that we have all the evidence to make the
best decision possible.
Mr. Hall. Well, thank you, Ms. Rubens. And you heard the
previous panel talk about the pods and triage, which seemed to
be a fairly popular and somewhat successful approach. At least
you are speaking positively of it.
There have been cases in research projects that were done
by the Centers for Disease Control and Prevention, I believe,
or the National Institutes of Health where, in the middle of a
study--if I remember correctly, I think it was hormone
replacement therapy (HRT) for women--in the middle of the
study, they realized that the evidence was so overwhelming that
they stopped the rest of the study and said, Let's all do this.
Let's recommend that women stop taking these HRTs because there
is risk to their health caused by that.
I can think of some others in terms of various
pharmaceuticals that were being investigated, where the
researchers themselves thought that it was so clear what the
outcome was going to be that they stopped the study and said--
for instance, Celebrex I can think of as one that was found to
be a health risk for most of the patients who were taking it,
and so doctors were advised immediately to stop prescribing, it
except in particular situations.
But my question is, is there a point at which you would
take this pod concept and/or the triage concept and just say,
okay, let's just do it at every RO? Do we have to wait? Is
there a long time necessary to do this if it seems to be
working?
Ms. Rubens. No, sir. There is not a long time necessary. In
fact, the area directors and the office field operation have
been working with Compensation and Pension Service to draft the
guidance that says here is how to put that mail processing,
that triage piece, up front right now. So that while we haven't
received the final report on this study, we are already taking
that piece of it and saying here is that guidance. Here is how
we put it together.
If I may, additionally, some of the early success that we
have seen in Pittsburgh insofar as that telephone contact with
veterans, we have also required already some phone calls up
front with the veteran to make sure that, when that VCA letter
has gone out, did you understand it? It is rather complex. Let
us make sure you get it. We are working on the right issues, as
well as mandating follow-up at intervals for claims that are
pending so that we can apprise the veterans of the progress
that we are making on their claims.
Mr. Hall. Well, that is encouraging. My next question
actually was going to be of phone calls, because the study Mr.
Christensen testified about apparently found that work credits
do not accurately reflect the effort involved in various
actions. Like telephone calls. VBA employees surveyed noted
that phone calls to claimants, as you just said, are the most
direct or quickest way to resolve claims. Calls are seldom
made, because the current work credit system does not award
credit for a phone call. So are we seeing steps? Is VBA taking
steps to change that, to award work credits for phone contacts?
Ms. Rubens. As part of the new VSR standards, the work
credit currently is going to be given out for establishing the
claim, beginning the development of the claim, getting that
claim ready to rate, so that all the evidence has been
gathered, as well as inputting the final decision and
authorizing the claims. So there really only could be four
steps that will get us credit.
As we did the study on the new VSR standards--and we had 10
stations participate in the study to evaluate how would this
work for a VSR--over 1,300 VSRs participated in gathering the
information. And some of the feedback that we got was the
encouragement of folks to pick up the phone and make a call in
an effort to get that ready for decision so that claim is now
ready and that credit could be garnered.
The challenge of the complexity of the claims will, I
think, show itself as we work to do the reviews of what does
the data show, now that we have implemented it nationally, at
the 30-day, 60-day, 90-day mark? And we sit down and look at
that with our AFGE Labor partners to say, is it working the way
we thought it would?
Mr. Hall. Thank you. As of May 1 of this year, there are
over 8,700 compensation claims pending before the New York RO,
nearly half of which have been waiting for over 125 days.
What can you tell my New York area veterans and those in
other Congressional districts about the work that is being done
to reform the system so that the staff--both line staff and
managers alike--focus on improving quality and still get the
benefits to the veteran in a timely manner?
Ms. Rubens. Yes, sir. Specifically to New York, as you
know, we have got a new management team in the New York
Regional Office. I am very excited about their innovative
approach, their collaboration that they have taken on their own
already with the local medical centers to ensure that we get
timely and accurate exams upon which to make decisions. And so
the efforts there with the new management team I think will
begin to, if you will, bear fruit as they help the employees
better manage the work in innovative ways that we have
developed locally.
At the national level, I mentioned some of the things that
we have done to generate ideas, whether it is internally,
whether it is through the roundtable that Chairman Filner
hosted, whether it is our National Innovation Initiative. And
we are working to put together an overarching approach to
improve nationwide some of the things that I heard of concern
here.
Interim ratings is one of the things that I have heard
discussed in terms of if there are three or four issues on a
claim and we can process one and need to develop further
information on the other. We are reinforcing the use of interim
ratings. It starts getting money flowing to the veteran and
starts getting them access to health care, and ensures that
they are in, if you will, our system and getting work done.
We are also looking at how do we segment claims. I heard
some discussion from some of the panel members about those one-
issue claims that might move more quickly, whether it is that
hearing loss claim or perhaps just one single issue, and are
currently piloting, in a couple of offices, how will that work.
About 26 percent of our work is a single-issue claim. And if we
can move those along more quickly, will we allow ourselves a
better focus, if you will, on those more complex claims,
whether it is a complex issue or whether it is a number of
issues.
I talked a little bit about the proactive phone
development. We have heard some concerns about whether or not
we are incentivizing and rewarding employees. I will tell you
that as we reward employees, quality is always a part of the
requirement for a reward to be given. But it is also about
that--I will call it ``less tangible monetary award,'' and it
is that recognition of who your performers are and making sure
that we are recognizing them for that effort.
One of the initiatives that we are developing and in which
the Secretary is interested in supporting is, if you will, a
Who's Who in VBA for VSRs and ratings specialists that will
allow us to recognize, quarterly, the top 25 in each of those
categories, and, at the annual level, with recognition from the
Secretary, in an effort to have people continue to stay jazzed
and focused on ``We have got to get this job done.''
I would be remiss if I didn't mention some of the efforts
that we are making in both the technology, if you will, the
VBMS, the Veterans Benefits Management System. We are standing
up an organization that brings VBA end-users, if you will,
field users and the Office of Information and Technology
organization together to be focused on this project that will
grow from the virtual regional office pilot that was just
completed in Baltimore, allowing us to change and pursue
actively the electronic claims processing system.
Mr. Hall. Well, thank you for all that. I am especially
happy to hear that you are moving toward more streamlined
granting of claims or approval of claims in clear-cut cases
like hearing loss.
Although I am a little bit disappointed that in 2008,
Congress passed a law unanimously, that was signed by President
Bush, that said the Secretary shall issue this partial claims
rating. Changed the language from ``may'' to ``shall,''
indicating the clear intent of Congress that when there is an
undisputed severe disability--which I think hearing loss might
fall under--or a loss of limb or a paralysis or blindness, or
any number of other things that are clearly service-connected
and are not in dispute--notwithstanding the possibility that
there may be many other facets of claims that need further
development or adjudication--that the Secretary shall award an
immediate partial rating so that money starts flowing to the
veteran. That was passed unanimously and signed by the previous
President. And 2 years later, I am surprised that we are
talking about being partway on the road to getting that done. I
would hope that we would have been there already.
In your written testimony, you state, Ms. Rubens, quote:
VBA does not and never has emphasized the quantity of claims
completed over the quality of our decisions. Unquote.
While this may be VBA's stated policy, I think the
testimony of other witnesses here demonstrates pretty clearly
that that is not actually true in practice, to say nothing of
the roughly 25 percent error rate nationally that the VA Office
of Inspector General reported to this Subcommittee in March at
our hearing on the STAR process in light of the staggering
rates of claims that are remanded or overturned by the Board of
Veterans' Appeals and the U.S. Court of Appeals for Veterans
Claims.
The message that I would like the VA to take from this
hearing is that speed cannot be the sole aim of reforming the
claims system or else the same problems will continue to plague
veterans. Timeliness will be a byproduct of an efficient and
accurate claims processing system.
So I would just hope that you can reassure me that VBA has
some idea how to effectively live up to the quality commitment,
while at the same time providing speed when it is appropriate,
as in the case of the undisputed severe cases that you were
speaking about, which I was mentioning also.
And I am also curious whether claims processors can be or
are being incentivized in a way to achieve both of these
goals--the accuracy, but also the credit for compensation--
flowing to veterans as soon as possible when that part of their
claim is not in dispute.
I also and the Committee needs to better understand the
ways in which VBA is emphasizing quality on a par with
quantity. And we would like to be reassured that the courts--
that the appeals levels are not being used as a backstop, and
that hopefully by triage and pod approaches, we may achieve a
higher accuracy rating the first time around.
I am sure these are all goals of yours, too. I know you
have a lot on your plate. I know that the VA has a lot of cases
and an increasing number of claims. Nobody thinks that you have
an easy job or that the Secretary has an easy job, or that
anybody who works at the VA has an easy job. But we are in a
position to hopefully provide you with resources to do what you
need to do, and all branches at the VA to do what needs to be
done for our veterans, but, at the same time, fulfilling our
Congressional role of oversight.
And to that end, seeing the report, which you have, would
be good, and at least having the knowledge that the law that
was passed in 2008 and signed into law is actually being
implemented. And hopefully that, as was requested then, that
claims processors and raters are being credited and rewarded
and that their evaluations are getting more positive. Not only
are they making more accurate decisions but they are, when they
can, speeding the delivery of compensation to the veterans.
Because for a veteran who is sleeping under a bridge, or for a
veteran who is having suicidal thoughts or family problems or
bankruptcy issues or adjustment, family adjustment problems,
all the things that we all know are happening, time is
important. And one of the ways we can help is by easing the
financial difficulties, especially in this difficult financial
time that the country is going through.
So I am not telling you anything you don't already know,
but I would appreciate your getting back to us. You can do it
in writing, if you would like, because I have a plane to catch
and you have probably heard enough by now. But if you would
like to take a couple minutes to answer, Ms. Rubens, I would be
happy to let you do that and then we will submit some more
questions to you in writing.
Ms. Rubens. Thank you. I do want to just--I didn't mean to
insinuate, to say that we hadn't been doing partial ratings all
along. I will tell you, though, that we have seen the
opportunity to allow us to achieve, if you will, one more piece
of that vision that the Secretary has; and that is, how do we
make sure that we are being the best advocates for veterans
that we can? And that is to make sure that not only are we
using them when they come up, but that we are actively pursuing
them, that we are actively encouraging our VSRs and ratings
specialists that, as quickly as they can--even if it is only
partial--that they are ensuring that they are starting that
flow of money, for the reasons that you stated in terms of the
challenge of a transition, the challenge of the economy and
homelessness, that we need to make sure that we are getting the
message across. We know we are a source of help for them, and
that is what we are here for.
I will tell you that I do not believe that we are using the
appeals process, if you will, as a backstop. We see about a 12
to 13 percent appeal rate. We don't think that is good. We know
we need to improve that. But it is also one of the measures
that we look at regularly from the standpoint of appeals,
remands, by individual regional office as you look at quality,
and make sure that that is part of the feedback that we give
not only to our directors but to our service center managers
and our employees who are doing the job on a day-to-day basis.
We recognize that it is possible to be both timely and have
a high degree of quality. We do have offices that have managed
to achieve those goals. And part of what we have to do is
invest in stealing those good ideas and making sure that they
are being implemented in other places; that we are requiring
them, and that we are holding ourselves accountable to meeting
that same level of service, which really does pair those two
things--a timely decision, made in a quality way.
Mr. Hall. Well, that is the last word, and thank you very
much for it. Thank you for your testimony and for your
commitment to working with us to improve the quality of
processing veterans claims.
And I will just state that all Members have 5 legislative
days to revise and extend their remarks.
We thank all our witnesses on our three panels today for
staying this afternoon. We value your insight and opinions and
your work on behalf of our veterans. This hearing stands
adjourned.
[Whereupon, at 5:03 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. John J. Hall, Chairman,
Subcommittee on Disability Assistance and Memorial Affairs
Good Afternoon.
Would everyone please rise for the Pledge of Allegiance?
Flags are located at the front and back of the room.
Ladies and gentlemen, I welcome you to today's hearing entitled
``Quality vs. Quantity: Examining the Veterans Benefits
Administration's Employee Work Credit and Management Systems.''
The purpose of the hearing is to examine how VBA's employee work
credit system and its Claims Processing Improvement (CPI) work
management system model may contribute to diminished quality,
accountability and accuracy in compensation and pension claims. Today's
hearing continues this Subcommittee's efforts to analyze various
elements of the compensation and pension claims process over the 111th
Congress, and marks the fifth oversight examination this year focused
on ensuring that our veterans and survivors properly receive their
benefits. It is our collective quest to vanquish VBA's backlog of
claims and appeals, which currently exceeds one million.
We also intended for today's hearing to provide an opportunity to
examine a congressionally-mandated report on the VBA's work credit and
management systems outlined in legislation that I developed and
sponsored during the 110th Congress, the Veterans Disability Benefits
Claims Modernization Act of 2008, H.R. 5892, (codified in P.L. 110-
389). The goal of this legislation, among other things, was to provide
VBA with a valuable roadmap to assess and improve its work credit and
management systems to produce better claims outcomes for our veterans.
The deadline for this report was October 31, 2009 and I note that
we have yet to receive it. However, VA has authorized its independent
research contractor that was retained to complete this report, the
Center for Naval Analyses (CNA), to testify before us today concerning
a summary of the report's findings and recommendations. VA advised the
Subcommittee that the report is still under review by the agency and
OMB, and that it should be transmitted to Congress soon. We look
forward to hearing today when this report will be ready and submitted
to Congress, and getting a better understanding of why it has not yet
been delivered.
Since 2007, the VBA has added over 7,100 claims processing
personnel and Congress has funded these requests. Yet the backlog still
climbs. This is not to say that adding additional workforce has not
been beneficial. Had Congress not provided these new claims processors,
the backlog might have been even worse than it is today, given the
exponential growth in claims receipts. As the VA itself acknowledged at
Chairman Filner's Claims roundtable in March, this is a sign of a
broken system. The mounting claims backlog is a symptom that can not be
addressed until the VA truly refocuses itself on adjudicating claims
correctly the first time. We need to continue to look at the system
with fresh eyes and determine how a new outlook can help VA fix its
claims processing system and get the claims backlog under control.
In convening today's hearing, the Subcommittee seeks to further
explore how the VBA's work credit incentives and flawed CPI model may
be significantly contributing to delays and errors in the claims
process. It is my hope that in continuing to examine this issue, we
will be able to help veterans secure the benefits they deserve and
prevent them from suffering further injury as a result of delays in
receiving disability benefits. That is why I want to revisit the issue
of partial, provisional and temporary ratings. I believe that if VA
increases the use of this authority and also awards a credit to claims
processing personnel who use it. This will go a long way in making sure
that many more veterans can begin to receive their benefits more
promptly. I would like VA to address this issue when it testifies.
Today we will also hear from Veterans Service Organization and
Veterans Advocacy Groups who will explain their vision for how the VA
should address the problem with VBA claims processing. From them, I
hope to gain a better understanding of the underlying issues that led
to such an unmanageable claims backlog at VBA, and if they believe that
VA is directing its efforts in the right direction to address the
issue. Specifically, I would like to know if you agree with VBA's
assertion that it emphasizes quality on par with quantity and
timeliness.
I look forward to the testimony of our witnesses and insightful
comments and questions from my colleagues on the Subcommittee. I now
recognize Ranking Member Lamborn for his opening statement.
Prepared Statement of Hon. Doug Lamborn, Ranking Republican Member,
Subcommittee on Disability Assistance and Memorial Affairs
Thank you Mr. Chairman,
I look forward to this afternoon's hearing on VA's work credit
system.
The purpose of this discussion is to ascertain whether proper
performance measures are in place to effectively gauge both efficiency
and accuracy of work.
A system that rewards work credits based on production alone
undermines quality, and as we all know, poor quality work has
ramifications throughout the entire system that have contributed to the
backlog of claims.
At the same time, there is also clearly a need for VA to maintain a
high level of efficiency so that veterans can begin receiving
compensation in a timely manner.
Where does the proper balance lie?
True quality means being effective and efficient, the key to
achieving this balance lies in how employees are rewarded for the work
they accomplish.
For too long, it appears that VA has placed too high an incentive
on production--but it is simply counterproductive to strive for high
numbers if the work has to be revisited at a later time.
Yet it would be equally detrimental to veterans if there was an
overemphasis on quality and the average handle time was off the charts.
This Subcommittee passed legislation during the last session to
obtain a study of the effectiveness of the VA's employee work credit
and work management system.
From this, we hope VA will be able to develop a more effective
means of improving its claims processing performance.
I look forward to working with my colleagues and Department
officials to delve into this issue and hopefully identify how the work
credit system can help incentivize the proper balance between quantity
and quality.
I want to thank the witnesses for their participation and their
testimony, and I look forward to our discussion today.
Mr. Chairman, I yield back.
Prepared Statement of Eric Christensen, Managing Director of Health
Research Policy, Institute for Public Research, CNA
In response to Section 226 of Public Law 110-389, the Veterans'
Benefits Improvement Act of 2008, the Department of Veterans Affairs
(VA) asked CNA to study the effectiveness of its current employee work
credit system and the work management system. Beyond these principal
areas of study, we considered other topics including the use of
information technology (IT) applications, methods of reducing the time
required to obtain outside information, processing of claims that are
ready to rate upon submittal, processing of claims from severely
injured (SI) and very severely injured (VSI) veterans, and an
assessment of best practices in claims processing. CNA conducted this
analysis between March and September 2009.
Due to the nature of our study questions and the short timeline for
this project, the most appropriate methodology was qualitative data
analysis. Our primary source of data was information collected from
interviews on site visits to six Regional Offices (ROs) selected by the
Veterans Benefits Administration (VBA). On these site visits we spoke
with employees in a wide variety of roles in order to obtain as
complete a picture as possible within the time constraints of the
study. We took detailed notes from each interview and reviewed them to
identify common themes among the responses. In total we spoke with 41
frontline employees, 49 managers, and 11 other employees. We
supplemented the information from our site visits with background
information from congressional hearings, formal evaluations from a
variety of sources (such as the Government Accountability Office (GAO),
VA's Office of Inspector General (OIG), and internal VBA projects),
conversations with VBA subject matter experts, and summarized VBA
administrative data.
Background
VBA faces multiple challenges in processing claims including large
increases in the number of claims submitted and the increasing
complexity of these claims. The increase in the number of claims
submitted is striking. For example, VA received about 719,000
compensation claims in FY 2008. This is a 53 percent increase from FY
1999.\1\ Reasons often cited for the increase are the return of
veterans from Global War on Terror deployments and the expansion of
benefit entitlements, such as new presumptions of service connection.
As for the complexity of claims, GAO reported that in FY 2006, 11
percent of claims that VA decided included 8 or more issues. By FY
2008, this proportion increased to 16 percent.\2\ We note these
statistics to illustrate the challenging and dynamic environment in
which VBA works to process claims.
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\1\ U.S. Government Accountability Office. Veterans' Disability
Benefits: Preliminary Findings on Claims Processing Trends and
Improvement Efforts. Testimony of Daniel Bertoni before the Committee
on Veterans' Affairs, U.S. Senate, 20 July 2009, GAO-09-910T.
\2\ Ibid.
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The work management system that VBA uses is the Claims Process
Improvement Model or CPI model. The CPI model is an organizational
model that promotes specialization as a way to improve quality and
timeliness. The model has separate claims processing teams to perform
functions in each of the following areas: public contact, triage, pre-
determination, rating, post-determination, and appeal. In this model
the triage team reviews and routes mail, enters basic claim information
into the computerized workload management system, and performs some
simple claims processing actions. From triage, claims move to the pre-
determination team, which primarily gathers the information necessary
to rate each claim. Once a claim is ready to rate, the rating team
decides whether a veteran's medical conditions are connected to
military service and if so, what the degree of disability is according
to the VASRD (Department of Veterans Affairs Schedule for Rating
Disabilities). Next the post-determination team processes (i.e.,
authorizes) awards and notifies claimants of the decisions made on
their claims. Outside of this process, the appeals team handles claims
for which claimants disagree with the award decision and decided to
appeal it and the public contact team conducts personal interviews and
responds to phone inquiries.
Veterans Service Representatives (VSRs), Rating VSRs (RVSRs), and
Decision Review Officers (DROs) are VBA employees that work on the
various teams in the CPI model. These employees are all subject to
minimum work credit standards. They earn work credits by performing
certain claims processing actions, each of which is assigned a specific
number of credits meant to reflect the time required to complete the
action. Employees' ability to meet the work credit standards is one of
the elements considered in their annual performance evaluations.
Note that VBA asked CNA to study its work credit and work
management systems to see how they could be improved. While there are
positive aspects to these systems, our charter was to look for areas of
improvement; hence, we report on areas for improvement only. Therefore,
one should not conclude that no part of these models works well because
we focused on areas for improvement only.
Work credit system
Findings
Stakeholders' main concerns about the current employee work credit
system are (1) that it emphasizes quantity over quality, (2) that
production standards are not based on a careful analysis of the tasks
performed, and (3) that work credits and production standards do not
reflect changes in claim complexity and additional duties imposed by
legislation.
Two recent surveys found strong evidence that VBA claims-processing
employees perceive that quantity is considered more important than
quality. The first was a survey of RVSRs and DROs conducted by VA's OIG
during March and April 2005.\3\ CNA conducted the second survey of
rating officials and Veterans Service Organization (VSO)
representatives for the Veterans' Disability Benefits Commission during
December 2006 and January 2007.\4\ Both surveys found very strong
evidence that rating officials perceive that quantity is considered
more important than quality. This is an important finding because even
if that perception is incorrect, at least some employees who have that
perception will probably change the way they process claims in order to
do what they think their supervisors want.
---------------------------------------------------------------------------
\3\ U.S. Department of Veterans Affairs, Office of the Inspector
General. Review of State Variances in VA Disability Compensation
Payments. Report No. 05-00765-137. May 2005.
\4\ D. Harris. Findings from Raters and VSOs Surveys, May 2007
(D0015934.A2).
---------------------------------------------------------------------------
From our analysis in this study, the perception that the quantity
of work receives more emphasis than the quality of work was common. The
overwhelming theme from frontline employees was that the production
standards are difficult to meet, whereas concerns about struggling to
meet the quality standards were rare. We infer from this that a
moderate increase in the number of quality reviews per employee would
better communicate to employees that VBA values both production and
accuracy. In addition, some interview respondents reported that they
feel the current number of reviews is too low to be representative of
their work, which certainly implies that some employees would even
welcome an increase in the number of quality reviews.
VBA has undertaken several of its own efforts to consider ways to
improve the work credit system. One of these efforts was a time-motion
study intended to provide information for updating the work credit
values. A more fundamental change that VBA is investigating is re-
defining all the actions for which employees receive credit in order to
better align them with the overall goal of completing claims. In
particular, VA established a VSR Performance Standards Workgroup that
recommended that VSRs receive work credit for only the following four
types of actions: (1) initiating development, (2) making a claim ready
to rate, (3) deciding an award, and (4) authorizing the award. At the
time of our report, VA was preparing to pilot test this approach at
multiple ROs.
Prior to developing this approach, the VSR Performance Standards
Workgroup conducted a survey of frontline employees and managers. It
included questions on perceived weaknesses in the current work credit
system, and the responses echoed what we heard through our evaluation.
The most commonly reported problems were that the performance standards
are outdated, there are inconsistencies across teams and ROs in the
rules for claiming credits, deductible time is subjective, the
standards are stagnant, the current system rewards churning of work,
and piecemeal development is the only way to meet the performance
standards.
Based on information from our site visits, we found that employees
generally feel that the work credit values in the current work credit
system do not accurately reflect the amount of time required for each
action. In particular, each action is too broadly defined to account
for the large degree of variation in complexity across claims. The
perceived inaccuracy of the work credits combined with the requirement
to meet minimum work credit standards and the perceived emphasis on
quantity over quality result in some unintended consequences for the
way in which claims are processed.
One of the most basic questions to consider about the employee work
credit system concerns the actual work credit values. Both frontline
employees and managers were overwhelmingly in agreement that the work
credits assigned to each individual action do not always accurately
reflect how much time is needed to perform that action for each claim.
Respondents reported multiple ways in which the work credit values are
not accurate. Some actions receive too much credit for the average
claim, some actions receive too little credit for the average claim,
and some actions receive no credit at all.
There is tremendous variation in the complexity of claims, and
based on information from our site visit interviews, the actions in the
work credit system are not defined at a level of detail to reflect that
variation. This implies that even if the work credit for an action is
accurate on average for claims worked over an extended period of time,
there's no assurance to the employees that the work credit they receive
for that action on any particular claim reflects the actual amount of
time required to be spent.
The two factors that respondents reported as the main determinants
of the difficulty of processing a claim were the number of issues and
the types of medical conditions. For some actions, the current system
allows extra work credit for claims with eight or more issues and for
claims with certain medical conditions that are difficult to adjudicate
(e.g., post-traumatic stress disorder). However, there is still a lot
of variation that is not taken into account. There was general
agreement that the number of issues on a claim is not adequately
addressed by the work credits system. In particular, the ranges for the
number of issues (1 to 7 issues and 8 or more issues) are too broad,
and performing an action for a claim with 7 issues should receive more
credit than for a claim with 1 issue.
There was also agreement that the particular medical condition or
conditions on a claim have a big effect on how much time a claim
requires. For example, respondents reported that actions on claims for
hearing loss are typically relatively straightforward and might even be
over-credited, whereas actions on claims with complex medical
conditions (such as traumatic brain injury) might merit additional
credit.
Some respondents indicated that one of the reasons they believe
that work credits do not accurately reflect the effort involved in
various actions is that the system has not been revised to account for
changes in the types of claims submitted. They specifically cited
increases in the number and complexity of issues.
Based on information from our site visits, one unfortunate effect
of the current work credit values is that VSRs tend not to use phone
calls to veterans to expedite development because there are generally
no separate work credits for those phone calls during the development
phase, even though sometimes a phone call is the most direct way to
resolve a question. Some of the VSRs who do make use of phone calls
said they have learned to work around the absence of work credits. They
do this by following up a phone call (for which they receive no credit)
with a letter (for which they do receive credit), even for cases where
they feel the letter isn't necessary. Thus, the lack of work credits
for phone calls slows development down both by discouraging some VSRs
from using a potentially good source of information and by causing
others to perform an unnecessary activity (writing a follow-up letter)
in order to get the work credits that they need.
We also heard about some examples of churning or piecemeal
development of claims such as spreading development over multiple days
to classify them as separate actions and therefore be able to claim
multiple credits. However, we do not know exactly how frequent or rare
piecemeal development is. We observed that most frontline employees are
genuinely concerned with serving veterans and their families and that
these types of activities are simply responses to the production
pressures that many employees feel.
Figure 1 shows the distribution of the average number of work
credits claimed per completed claim for all the ROs. If all ROs were
processing the same set of cases in the same way, and if all employees
were claiming the same work credits for the same actions, then we would
expect minimal variation across ROs. Instead, we found that the average
number of work credits per claim at each RO ranged from 5.2 to 17.7,
with substantial variation within that range. These results do not
account for average differences in the types of cases across ROs, and
those differences certainly could explain some of the differences in
work credits per claim. However, the sizable magnitude of variation
raises questions.
Figure 1. RO's average work credits per claim
[GRAPHIC] [TIFF OMITTED] T7021A.001
The existence of unintended consequences such as rushed actions and
piecemeal development, have negative effects on both the quality and
timeliness of claims processing. The first step toward eliminating them
should be a pilot to develop a set of actions and associated work
credits that accurately reflect, and are perceived to accurately
reflect, the time required to perform each action at a targeted level
of quality. Those work credit values can then be combined with
information on expected caseload to determine the staff required to
process that caseload at that quality level. Because these changes will
not be quick to implement, VBA should determine what the trade-off
between quality and quantity is under current resource constraints and
then explicitly decide on which levels of quality and quantity best
contribute to accomplishing VA's mission.
Recommendations
To address both the issues of work credit values and increasing the
perceived emphasis on quality, we recommend conducting a pilot test of
the effectiveness of taking the following steps, in the order
indicated:
1. Develop a list of actions defined so that there is little
variation across claims in the time required to perform the action.
This will probably require accounting for the number of issues and the
specific medical conditions involved.
2. Determine the time that is required (i.e., the work credits) to
perform each action at a certain average level of quality. This will
require incorporating the fact that employees with different levels of
experience (i.e., different GS levels) will need different amounts of
time to achieve the same average level of quality.
3. Communicate information to employees about the methodology used
in developing the new work credits. The goal is for employees to
understand that the work credits accurately reflect the time that
should be required for each action. In addition, they should understand
how accuracy of claims processing was explicitly incorporated into the
development of the work credits and thus how important quality is to
VBA.
4. Set the daily work credit performance standards for each
individual employee to match the number of available work hours per
day. Since the work credits from step #2 above will have been developed
to equal the time required for each action, setting daily standards to
match the time available ensures that employees should not perceive a
need to rush. This recommendation is for staff's ease of understanding
work credit values.
5. Set the RO production standards so that they can be attained
when employees are working at the work credit standards from step #4
above. (This contrasts with what we heard about the current RO
standards, which apparently cannot be met if all frontline employees
are working only at their minimum work credit standards.)
6. Develop mathematical models to predict how the number and
complexity of claims translate into the number of employees needed to
complete those claims. Then, apply the model to the predicted caseload
to calculate the number of employees needed in the future to handle
that caseload. Plan to increase or decrease the number of claims
processing employees accordingly.
7. Conduct ongoing analysis and revisions of the actions, work
credit values, and number of employees needed. The ongoing analysis is
required to account for the fact that there are continuing changes in
the complexity of claims, in the legal requirements about what must be
done for each claim, and in IT system capabilities.
We consider the following options for redefining actions (step 1)
as only two examples among the numerous possible alternative
approaches.
One option is to base the detailed list of actions on the four main
types of actions proposed by the VSR Performance Standards Workgroup,
which are initiating development, making a claim ready to rate,
deciding an award, and authorizing the award. Within each of those four
types of actions, the work credit values would vary to account for
differences in complexity of claims by number of issues, types of
medical conditions, and any other factors found to be good predictors
of how much time the action requires.
One advantage of this approach would be that employees could focus
more on the actual performance of actions rather than spending time
recording a lot of separate smaller actions. Another advantage would be
that employees would have a lot of incentive to perform only those
activities that make a definite contribution to completing the claim. A
disadvantage of this approach would be that work credits would be
``lumpy,'' by which we mean they would be relatively large but there
would be only a few points in processing a claim at which work credits
could be claimed. This could be a problem if there were a day or even a
week in which a VSR was in the middle of intensive development
activities for a large number of claims, but by chance none of the
claims became ready to rate during that day or week because the
external parties from whom supporting information had been requested
were not responding. In that case, the VSR would earn zero credits for
that time period.
A second option is to base the detailed list of actions on a
comprehensive list of all the individual activities that employees
perform in the process of doing their jobs. The main advantage and
disadvantage of this option would be directly opposite to those
described in the first example above. Specifically, the disadvantages
would be that not all actions make a direct contribution to completing
the claim and that the frontline employees would need to spend time
recording each of their many separate actions in ASPEN (Automated
Standardized Performance Elements Nationwide). However, the advantage
would be that this approach would produce detailed records on each
frontline employee's specific activities, which would provide both
frontline employees and managers with very precise information on
exactly how much work the employees have done for any given time period
and therefore how well they are on track to meet the month's minimum
work credit standards.
In addition to the seven recommended steps, we also have the
following individual recommendations for actions that would contribute
to the effectiveness of the work credit system:
As discussed earlier, conducting more quality reviews
would better communicate to staff that quality is a priority for VBA.
If the RO internal quality reviews counted deviations
from official procedures for claiming work credits as errors (instead
of just as ``comments''), then that would improve adherence to
procedures, thereby improving quality.
If there were work credit deductions for actions on which
there were errors, then that would improve quality.
In the long term, if VETSNET could be modified so that it
captures work credits automatically as a claim moves through the stages
of processing, then that would save time for employees in recording
their work credits, and it would ensure that work credits are logged
more accurately and consistently across staff and ROs.
Work management system (CPI Model)
VBA's current work management system is the Claims Process
Improvement Model. The CPI model is not VBA's first attempt to manage
the claims process by dividing it into separate stages and passing a
claim along to a different person at each stage. In the 1990s, VBA was
using a similar model called the ``unit model.'' That model resembled
the CPI model in that employees were specialized so that the various
functions of claims processing (e.g., development, rating,
authorization) were performed by different people. The main difference
between the unit model and the CPI model was that employees were not
organized into teams in which everyone on the team performed the same
function. Instead, each team consisted of employees who performed
different functions so that they collectively covered all the necessary
claims processing functions.
In the late 1990s, there was a business process reengineering (BPR)
effort in which a VBA guidance team analyzed the key challenges facing
claims processing. Among those challenges were a lack of individual
accountability and an emphasis on quantity of work over quality. The
team's solution was a ``case management model'' in which each claim was
handled by only one VSR and a rater who made the rating decision. VBA
used this model until it adopted the CPI model in response to concerns
about problems with timeliness.
It's not difficult to see the cyclical pattern of recurring
concerns that led to switching between two basic types of approaches
(more vs. less employee specialization), each of which has different
advantages and disadvantages. The key question then is which approach
has stronger advantages than disadvantages, and based on our synthesis
of information that we obtained from our site visits, the answer is not
straightforward.
The main motivation for studying the CPI model is the concern that
quality and accountability are lacking because many different people
are involved in processing each claim. Our analysis finds that two of
the main distinguishing features of the CPI model, i.e., the
specialization of VSRs and the fact that claims are passed through a
series of specialized teams, have both advantages and disadvantages for
the quality and timeliness of claims processing. In particular, VSR
specialization improves quality and timeliness (compared to a model
with less specialization but more continuity in the staff who work on
each claim), but the movement of claims across teams reduces quality
and timeliness. The issue is to determine whether the improvements
outweigh the disadvantages. Thus, the net effect of the CPI model is
unclear, which means that before making any changes to its approach to
claims
**** MANUALLY BROKE PARA TO PREVENT BAD BODONI DASH BREAK
**** deg.
processing, VBA should conduct a pilot study to confirm that those
changes will actually produce the desired net improvements.
At the time of our report, VBA was already conducting a pilot study
to test an alternative to the CPI model that, based on its design,
appears to have the potential to improve both quality and timeliness.
Consequently, we recommend that VBA wait for the results of that study
before deciding whether it would be worthwhile to investigate other
alternatives.
Specifically, VA was conducting a pilot study in the Little Rock
RO, and one of its main elements is testing the use of claims
processing teams (called ``pods'') that contain pre-determination,
rating, and post-determination functions. One of the expected benefits
of organizing employees into pods is ``improved quality resulting from
more rapid identification and resolution of errors within the team
(i.e., errors will be detected much closer to the point of
occurrence)''.\5\ This approach also retains the current specialization
of VSRs. Thus, the current pilot study is testing a model that appears
to have reasonable potential to improve quality compared to the CPI
model, especially if organizing employees into pods creates a greater
sense of accountability than in the CPI model's function-based teams.
Consequently, we do not see any reason to pilot test another approach
(e.g., the hypothetical one we consider above) unless the results of
the current pilot show that the use of pods does not result in claims
processing outcomes any better than&ose obtained under the CPI model.
---------------------------------------------------------------------------
\5\ Booz Allen Hamilton. Veterans Benefits Administration
Compensation and Pension Claims Development Cycle Study. Final Report.
5 June 2009.
---------------------------------------------------------------------------
It is also important for all stakeholders to consider the
possibility that different work management systems might ultimately
produce similar outcomes. On our site visits, we heard from a number of
managers who thought that the specific claim processing model is less
important than managers' abilities in implementing it. This line of
thinking suggests that only limited improvements could be obtained from
changing the approach to claims processing. VA should certainly be
using the approach that will best produce the quality and timeliness
results it wants. However, other factors, such as certain IT
improvements, could easily have much more impact than changes to the
claims processing approach.
Other study topics
In the area of IT use, VA has been proceeding with its efforts to
increase the use of paperless processing, and that strategy seems to
have the most long run potential for improving timeliness and quality.
VA has investigated the possibility of using rules-based applications
for the rating decision, but the subjective nature of many of the
current VASRD criteria would make implementation of that approach
extremely challenging.
Timely development of claims is essential to the timely completion
of claims, and VBA could improve development time by encouraging more
use of telephone contacts to obtain information from claimants and
third-party organizations. The best way to encourage this would be to
provide appropriate work credit for phone development. Currently, some
employees who use phone contacts for development report that they also
follow up with a letter that's not always necessary because sending the
letter is what enables them to claim sufficient work credits to meet
their minimum performance standards.
On the topic of claims that are ready to rate at the time they're
submitted, we found that there are no standard practices across ROs for
handling those claims. There is currently a pilot study to determine
the potential for a program in which ``fully developed claims'' receive
expedited treatment, and depending on the results of that pilot, it is
possible that VA will establish such a program at all ROs. If it does,
then it seems likely that any special procedures that ROs have
developed for ready-to-rate claims would be superseded by the program
for fully developed claims.
Another category of claims that we were asked to address is claims
from SI and VSI veterans. The practice reported to be effective in
ensuring that those claims are processed promptly is to designate
specific individuals to be responsible for following those claims
extremely closely through all phases of processing.
Until recently, VBA did not formally assess or disseminate best
practices for claims processing. Instead, managers tended to learn
about practices at other ROs through informal contacts. We heard from
managers that they would like more access to information on alternative
approaches that other ROs have found to be successful, but because of
the many differences among ROs, the managers would prefer that any
practice reported to work well at one RO be presented as a suggestion
rather than as a requirement. In July 2009, VBA issued a standard
operating procedure for identifying best practices and disseminating
them on their Quality Assurance Web site. So, in the future, it should
be easier for managers at ROs to access information regarding best
practices.
Prepared Statement of Richard Paul Cohen, Executive Director,
National Organization of Veterans' Advocates, Inc.
MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:
Thank you for the opportunity to present the views of the National
Organization of Veterans' Advocates, Inc (``NOVA'') concerning the
Veterans Benefits Administration Employee Work Credit and Management
Systems.
NOVA is a not-for-profit Sec. 501(c)(6) educational organization
incorporated in 1993. Its primary purpose and mission is dedicated to
train and assist attorneys and non-attorney practitioners who represent
veterans, surviving spouses, and dependents before the Department of
Veterans Affairs (``VA''), the Court of Appeals for Veterans Claims
(``CAVC''), the United States Court of Appeals for the Federal Circuit
(``Federal Circuit'').
NOVA has written many amicus briefs on behalf of claimants before
the CAVC and the Federal Circuit. The CAVC recognized NOVA's work on
behalf of veterans when it awarded the Hart T. Mankin Distinguished
Service Award to NOVA in 2000. The positions stated in this testimony
have been approved by NOVA's Board of Directors and represent the
shared experiences of NOVA's members as well as my own eighteen-year
experience representing claimants before the Veterans Benefits
Administration (``VBA'').
P.L. 110-389
In October 2008 Congress passed S. 3023, enacted as P.L. 110-389,
and titled the ``Veterans' Benefits Improvement Act of 2008'' (``the
VBIA 2008'' or ``Act'').
Among the reports which the Act required the VA to submit to
Congress, before the end of 2009, is a report on a study conducted on
the effectiveness of the current VBA employee work credit and work
management systems. Act, section 226.
VA COMPLIANCE WITH P.L. 110-389
As of the date this testimony was submitted, NOVA has not seen a
copy of the VA's required report to Congress. Moreover, as of May 1,
2010, the VA's required report had not been submitted to Congress.
THE WORK CREDIT SYSTEM
For many years NOVA's members have noticed large numbers of
inaccurate compensation and pension decisions which we attributed, in
part, to lack of effective training of VA employees and to their
cursory review of claims folders.
One of the first published studies to confirm that the VA's present
work credit system prevents accurate decision-making was the May 19,
2005 report from the VA Office of Inspector General, ``Review of State
Variances in VA Disability Compensation Payments'', Report No. 05-
00765-137 (``the Report''). According to the IG, the VBA's national
production standards which must be equaled or exceeded by each Regional
Office (``VARO'') include, for journeyman Rating Veterans Service
Representatives (``RSVRs''), 3 to 5 weighted cases per day, based on
the type of claim and the number of claimed disabilities or issues
rated; from 3 to 7 weighted cases per day for those working from home;
and from 3 to 4 weighted cases per day for Decision Review Officers
(``DROs''). Report, page 60.
Sixty-five percent of those VA employees who responded to the IG's
questions (questionnaires were sent to 1,992 rating specialists and
DROs) reported insufficient staff to insure timely and quality service.
More troubling is the report by 57 percent of those responding that it
is difficult to meet production standards if they adequately develop
claims and thoroughly review the evidence before issuing rating
decisions. And, 41 percent of those responding estimated that 30
percent or more of the claims were not ready to rate when presented for
rating. Report, pages viii, 58, 60.
An additional indictment of the work credit system is contained in
the June 5, 2009, Booz Allen Hamilton Final Report, ``Veterans Benefits
Administration Compensation and Pension Claims Development Cycle
Study'' (``Booz Allen Report'') which noted that, although the work
credit system ties employee performance standards to the system, the
work credit system ``does not measure individual contribution to VARO
production goals . . . [and] does not track the number of claims made
ready to rate or the amount of time a VSR needs to prepare a claim for
rating.'' Booz Allen Report, pages 16, 17. Furthermore, the work credit
system is processed utilizing software known as the Access Standardized
Performance Elements Nationwide (``ASPEN''), an automated database
maintained on the VBA's information technology system, which relies
upon self reporting of specific actions taken during the processing of
a claim, for example, .5 credits for conducting follow-up work on a
claim already in development, but 1.5 credits for sending a VCAA
notification letter. Booz Allen Report, pages 5, 16. More specifically,
in 2010, Veterans Service Representatives (``VSRs'') received 1.25
credits for issuing a Veterans Claims Assistance Act (``VCAA'')
notification letter to a veteran claiming 1 to 7 disabilities and 1.5
credits if the veteran claimed 8 or more disabilities. September 23,
2009, Report from the VA Office of Inspector General, ``Audit of VA
Regional Office Claims Processing Exceeding 365 Days'' Report 08-03156-
227, page iv.
The American Federation of Government Employees, AFL-CIO, has
stated that work credits are not properly assigned for the various
tasks necessary for processing a claim which causes VBA employees ``to
short cut those tasks that are undervalued, such as additional case
development.'' Statement of John McCray, AFGE, February 3, 2010, before
the House Subcommittee on Disability Assistance and Memorial Affairs,
page 5. Additionally the work credit system has led to a hostile work
environment in which additional stress is imposed by ``arbitrary
increases in production requirements.'' Statement of John McCray, AFGE,
February 3, 2010, before the House Subcommittee on Disability
Assistance and Memorial Affairs, page 2. The result of the VA's
periodic increases in required production standards has been ``a
dramatic drop in both accuracy and station production. . . .'' id.,
page 2.
ACCURACY
The STAR Program
Accuracy in VBA decision-making is reported in and is measured by
STAR, Statistical Technical Accuracy Review, which requires reviewers,
who are VBA employees, to review for accuracy a statistical sample of
cases worked by each regional office. According to the 2005 IG report,
the VBA's error rate was 13 percent in 2004. Report, page 55.
There is presently no 100 percent reliable way to assess the VBA
accuracy rate because there are no available statistics on the number
of incorrect rating decisions which are not appealed, nor on the number
of partially correct rating decisions, containing incorrect effective
dates or disability percentages, which are not appealed. Rather than
rely on the VBA's misleading published accuracy rates, one commentator
suggests that review of the claims which are appealed to the BVA is
more informative. Benjamin W. Wright, The Potential Repercussions of
Denying Disabled Veterans the Freedom to Hire an Attorney, 19 FCBJ 433,
440 (2009).
Statistics from the Board of Veterans Appeals for FY 2007, suggest
a VBA error rate over four times as large as that reported by the VBA
for those decisions which were appealed to the BVA. Thus, in 2004 it
took on average 937 days, or 2\1/2\ years from initial appeal, or
Notice of Disagreement, to final Board decision, see Report Chairman of
Board of Veterans Appeals, FY 2004, page 8, http://www.bva.va.gov/docs/
Chairmans_Annual_Rpts/BVA2004AR.pdf.
Review of the Chairman's Annual Report for FY 2007, page 20, http:/
/www.bva.va.gov/docs/Chairmans_Annual_Rpts/BVA2007AR.pdf which would be
expected to contain decisions on appeals from those VBA decisions
appealed in 2004, shows that, in 2007, 41 percent of the appeals to the
BVA were denied, leaving 59 percent which were reversed or remanded
because of errors by the VBA, not the 13 percent error rate which was
reported in STAR.
The Use of ASPEN
Another information technology system utilized by VBA to track
performance of VSRs, RVSRs, and DROs, is the Access Standardized
Performance Elements Nationwide (``ASPEN''). Booz Allen Report, page 5.
Problems with this system include that it reflects a random internal
review by a Super Senior VSR who pulls the file, reviews the case, logs
the result in ASPEN and returns the file. Not only might the internal
reviewer's judgment be questionable, but the delay in providing
feedback can be as long as six weeks. The procedure discourages
employees from revealing problems, and does not emphasize problem-
solving and root-cause analysis. Booz Allen Report, page 18.
MANAGEMENT
Because the VBA changed the claim processing model from the unified
team case management approach to the Claims Processing Improvement
(``CPI'') model, utilizing six separate teams, and separating pre-
determination (development) from rating and post-determination and
appeals, ``work moves in large batches to the next step before it is
actually needed . . . claims spend time waiting in queues between
process operations . . . [and there is] overlapping, redundant, and
sometimes unnecessary work activities.'' Standardized step-by-step
instructions are not provided. Team members lack immediate and
unambiguous feedback because limited visual management cues are
provided. Additionally, employees are ``not sure how the quality of
their work impacts the next step in the process, or how their work
contributes to the quality of the final product.'' Booz Allen Report,
pages 3, 13, 14, 18.
Not only does the use of the CPI model cause delays, but the
present system, which requires the assignment of work to a VSR
utilizing a system based on the last two digits of a Veteran's claim
number, leads to short term ``backlogs and delays by not routing work
to available VSRs,'' Booz Allen Report, page 14.
A further inefficiency is caused by VBA's use of supervising
managers who are not adequately trained. Statement of John McCray,
AFGE, February 3, 2010, before the House Subcommittee on Disability
Assistance and Memorial Affairs, page 3.
NOVA'S SUGGESTIONS
Booz Allen's Cycle Study highlights systemic problems of delays,
inefficiencies and inaccuracies present in and created by the VBA's
claims adjudication process which are well known to those who practice
in this field and are consistent with the findings contained in the
2005 report by the VA Office of Inspector General concerning the effect
of the work credit system on inducing VA employees to prematurely and
inaccurately rate claims.
NOVA supports the Booz Allen recommendation to return to a pod team
approach and to encourage VA employees to take the time necessary to
process a claim correctly the first time. Further, rather than
utilizing the present obstructing work credit system, VA employees
should be evaluated on the correctness and completeness of their
actions to advance the efficient, timely and accurate resolution of the
claim. Because most of the delay in processing claims involves
development, particularly waiting for and obtaining C&P exams, \1\ NOVA
also suggests that 38 U.S.C. Sec. 5125(a) be amended to require the VA
to forego obtaining an additional exam where the record already
contains an exam sufficient for rating purposes which would result in a
grant of the benefit requested.
---------------------------------------------------------------------------
\1\ March 17, 2010, Report from the VA Office of Inspector General,
``Audit of VA's Efforts To Provide Timely Compensation and Pension
Medical Examinations'' Report 09-02135-107, pages i, 11; September 23,
2009, Report from the VA Office of Inspector General, ``Audit of VA
Regional Office Claims Processing Exceeding 365 Days'' Report 08-03156-
227, pages iii, 4, 8, 9; Booz Allen Report, page 12.
---------------------------------------------------------------------------
Additionally, NOVA recommends the creation of independent quality
control teams to monitor accuracy and efficiency and to provide the
additional service of conducting on the job training by reviewing
claims folders with VSRs, RVSRs, and DROs. Obviously, suitable training
is a crucial component of a system designed to make the correct
decision the first time. More time and resources need to be devoted to
ensuring that all VA employees who handle claims are adequately trained
to do their job in an accurate and timely manner.
Prepared Statement of Ronald B. Abrams, Joint Executive Director,
National Veterans Legal Services Program
Mr. Chairman and Members of the Committee:
I am pleased to have the opportunity to submit this testimony on
behalf of the National Veterans Legal Services Program (NVLSP). NVLSP
is a nonprofit veterans service organization founded in 1980 that has
been assisting veterans and their advocates for 30 years. We publish
numerous advocacy materials, recruit and train volunteer attorneys,
train service officers from such veterans service organizations as The
American Legion and Military Order of the Purple Heart in veterans
benefits law, and conduct quality reviews of the VA regional offices on
behalf of The American Legion. NVLSP also represents veterans and their
families on claims for veterans benefits before VA, the U.S. Court of
Appeals for Veterans Claims (CAVC), and other federal courts. Since its
founding, NVLSP has represented over 1,000 claimants before the
Department of Veterans Affairs (VA) and the Court of Appeals for
Veterans Claims (CAVC). NVLSP is one of the four veterans service
organizations that comprise the Veterans Consortium Pro Bono Program,
which recruits and trains volunteer lawyers to represent veterans who
have appealed a Board of Veterans' Appeals decision to the CAVC without
a representative. In addition to its activities with the Pro Bono
Program, NVLSP has trained thousands of veterans service officers and
lawyers in veterans benefits law, and has written educational
publications that thousands of veterans advocates regularly use as
practice tools to assist them in their representation of VA claimants.
NVLSP has been asked to testify about the quality vs. quantity
tension that exists in almost every production system--in the
production of televisions, in the production of automobiles and in the
production of decisions on claims for VA disability benefits.
Television and automobile companies would like to produce as many
products as quickly as they can; however their need for production is
tempered by their certain knowledge that if they produce automobiles or
televisions that have lousy quality people will not buy their products
because consumers seeking televisions or automobiles have other
choices. But veterans seeking VA disability benefits can only turn to
the VA. They are stuck with the quality of the product the VA produces.
As you know, there is always tension between quantity and quality.
In fact, faced with a growing backlog caused by a surge of claims from
OIF and OEF veterans and with the compounded impact of many years of
premature adjudications that forced claimants to appeal or file
reopened or repeat claims, the issue of quantity vs. quality has gained
increased importance. Unfair, premature denials cause unnecessary
appeals and years of delay before deserving veterans obtain justly
earned benefits. Adjudicating many claims quickly does no good if many
of these adjudications are premature and many deserving veterans are
unfairly denied.
The most important and pervasive problem facing veterans seeking VA
disability benefits is the eagerness of some VAROs to adjudicate claims
before all necessary evidence has been obtained. For example, some
VAROs prematurely deny claims based on inadequate VA examinations. In
some cases, even where the VA examiner clearly fails to respond to a
specific question asked by the RO, the examination report is not
returned as inadequate. Instead, the claim is adjudicated and denied on
the basis of the inadequate report. In other instances, claims are
denied before all service medical records are received. Other claims
are sometimes denied before the veteran has a fair opportunity to
submit independent medical evidence. These all-too-frequent cases of
premature denial result from an over-emphasis on timeliness and a lack
of accountability.
It is clear to NVLSP that the way the VA evaluates its adjudicators
and the way the VA awards work credit encourages sloppy adjudication
resulting in premature, unfair denials. Therefore, the first thing
stakeholders and those who manage the VA need to do is to admit there
is a real and very serious problem with the quality of VA
adjudications. NVLSP believes that the problems within the VA claims
adjudication system are so serious that band aids (such as: paper-free
or electronic claims processing, and a return to the team adjudication
approach) will not be enough to fix the problem.
NVLSP has learned that the Veterans Benefits Administration is
considering changing how its raters and adjudicators are evaluated, and
we eagerly anticipate reviewing these changes once they are final. We,
however, advise the Veterans Benefits Administration not to simply make
cosmetic changes to the quality, timeliness and output (production)
standards for VSRs and RVSRs and expect significant improvement. For
example, increasing the quality or accuracy standard from 83 percent to
85 percent for a GS-9 adjudicator could be considered just a
superficial change because the current crop of GS-9 adjudicators are
having trouble meeting the current 83 percent accuracy rate goal.
Unless VBA changes the current system, a system that rewards VA
managers for premature denials, there will be no substantive change in
the quality of work performed by the VA regional offices.
In the opinion of NVLSP, the current VA employee and work
management systems reflect a system that was created to serve the needs
of the bureaucracy rather than the needs of the veteran. Veterans do
not care about the VA need for: work credit; for productivity
statistics; and for timeliness statistics. From the point of view of a
veteran claimant it is just one claim even if the VARO improperly
adjudicated his claim five times and the BVA remanded it three times
over the course of 10 years. The primary goal of VBA should be to
provide the best service to veterans. It makes sense that the VA work
measurement system should reflect and support that goal. What is
easiest for the VA bureaucracy is not necessarily best for veterans.
NVLSP suggests that final work credit should not be awarded until
the appellate period expires or when the BVA makes a final decision.
That would encourage the VAROs to completely and correctly adjudicate
claims at the earliest possible time. It would also incentivize VA
managers to encourage their adjudicators to ``do the claim right the
first time'' because a correct, complete adjudication would be in the
best interest of the VA manager.
Therefore, NVLSP suggests that the VA restructure its work credit
and work management systems to reflect the needs of its veteran
claimants and then restructure its bureaucracy so that veterans can be
best served. The VA needs to balance its competing needs for timeliness
and production with the need to provide quality service to its
claimants.
I. The Unfair VA Work Measurement System
The current VA work credit system prevents the fair adjudication of
many claims for VA benefits. The current VA work credit system needs to
be overhauled because it rewards VA managers and adjudicators who claim
multiple and quick work credit without complying with the statutory
duties to assist claimants obtain evidence that would substantiate
their claims and notify claimants of what evidence would substantiate
their claims.
No matter how much the average VA employee wants to help the client
population, the VA decision-making culture, fueled by the VA work
measurement system, penalizes many VA adjudicators for doing a good
job. The VA has created a work measurement system for deciding
critically important claims that is driven by weighty incentives to
decide claims quickly. How the VA measures its work and evaluates the
performance of its employees continues to have a major impact on the
adjudication of claims for veterans benefits.
Responsibilities of VA managers that protect the fairness of the
adjudicatory process--such as ``control'' of claims, supervisory review
of unnecessarily delayed claims, thorough development of the evidence
needed to decide a claim properly, recognition of all of the issues
involved, provision of adequate notice, documentation that notice was
given, and careful quality review--all adversely affect the
productivity and timeliness statistics (that is, how many decisions on
claims are made within a particular period of time) for the VA manager.
Consequently, proper attention by VA managers to their legal
obligations very often adversely affects the statistics upon which
their performance is rated.
II. The Impact of Judicial Review
The VA claims processing (or claims adjudication) system has been
exposed by judicial review. To say there is a crisis in VA claims
adjudication is an understatement. Statistics from the Board of
Veterans' Appeals (BVA) and the U.S. Court of Appeals for Veterans
Claims (CAVC) show that nationally, for FY 2009, over 60 percent of all
VA regional office appeals reviewed by the BVA were reversed or
remanded and over 80 percent of CAVC decisions on the merits reversed,
or remanded BVA decisions. Please note that for FY 2008 the CAVC
reversed and remanded only 63 percent of all merits decisions.
Based on the experience of NVLSP (over 12 years of quality reviews,
in conjunction with The American Legion, of over 40 different VA
regional offices combined with extensive NVLSP representation before
the CAVC), the most egregious VA errors are a result of premature
adjudications. For example, many errors identified by Legion quality
reviews reveal that VA adjudicators failed to even try to satisfy its
statutory duty to assist the claimant by obtaining the evidence needed
to substantiate the claim, and incorrectly accepted and prematurely
denied claims based on inadequate evidence (especially inadequate VA
medical examinations).
I have been told by a variety of VARO officials that because of
pressure to produce end products and reduce backlogs, they
intentionally encourage the premature adjudication of claims. This
statement is based on my experience as a VA employee, and based on my
experience as a member of the Legion quality review team.
Fixing the VA work credit system is a topic that is near and dear
to my heart. I have been involved in various aspects of veterans law
(working for the VA and then NVLSP) for about 35 years. My experience
tells me that unless the system is corrected most well-meaning attempts
to improve VA claims adjudication will not be successful because the
driving force in VA adjudication will continue to be claiming quick
work credit.
III. The Inadequate Quality of VA Adjudications Is a Major Influence on
the Size of the Backlog
It is clear that the quality of VA adjudications is not
satisfactory and is a major contributor to the size of the backlog.
Because many claims are improperly denied, because many VA adjudicators
are inadequately trained, because many VA regional offices are
improperly managed, because many VA regional offices are inadequately
staffed, and because VA Central Office management has not acted to fix
these problems in any meaningful way, many veterans and other claimants
for VA benefits have to file unnecessary appeals, wait several years
for a BVA remand, and wait for the VA to obtain evidence that should
have been requested during the original adjudication of the claim.
These appeals clog the system and create unneeded work for the VA. Of
course, it would have been better for the VARO to do the work correctly
the first time.
The VA is now receiving many claims submitted by OIF and OEF
veterans. These claims will obviously increase the backlog and increase
VA workload. Dealing with this wave of claims will become especially
daunting if many of these claims are improperly denied in an effort to
artificially decrease the backlog and improve VA managers' timeliness
and productivity statistics. This makes it even more important that the
VA adjudication system be improved now.
Potential Solutions
The VA work measurement system has to be overhauled. H.R. 3047
which, in Section 2 would change when VA regional offices (VAROs) can
claim work credit, was a good bill that would have accomplished this
goal. NVLSP looks forward to reviewing the overdue VA report that was
mandated by P.L. 110-389.
The VA needs to acknowledge the complexity of its claims
adjudication system and continue to increase the number of adjudicators
to work these claims. The following suggestions should be considered:
The VA should be required to submit to an independent
quality review to validate the quality of work performed in the
individual VA regional offices.
The grade levels of VA raters and Decision Review
Officers should be raised and these employees should be held
accountable for the quality of their work.
Even though additional adjudicators have been hired,
Congress needs to continue to provide additional funding for more
adjudicators if the workload requires more adjudicators. The additional
adjudicators, once properly trained, should help prevent the VAROs from
brokering cases (sending cases from one VARO with too much work to
another VARO). In the opinion of NVLSP, brokered cases are less
accurately adjudicated than most cases and cause continuing problems
for the originating VARO.
The VA should consider going back to the ``team'' concept
in the VAROs.
Adjudicating from electronic records is a laudable goal
if complete records can be obtained and if the database permits logical
searches.
Finally, the adjudication culture at the VAROs needs to
be changed. Many VA managers act like they are producing widgets rather
than adjudicating claims filed by real people. Their goal should not be
just prompt adjudication; the goal should be a timely, accurate and
fair adjudication--which in the long run is the fastest way to finally
adjudicate claims.
I want to stress that NVLSP is not demanding perfection from VA
managers and adjudicators. NVLSP, however, feels that unless the VA
changes the way it counts its work, there will be no significant
improvement.
Thank you.
Prepared Statement of James D. Wear, Assistant Director, National
Veterans Service, Veterans of Foreign Wars of the United States
MR. CHAIRMAN, RANKING MEMBER LAMBORN, AND MEMBERS OF THE COMMITTEE:
On behalf of the 2.1 million men and women of the Veterans of
Foreign Wars of the U.S. (VFW) and our Auxiliaries, we appreciate the
opportunity to present our views before you today. The Veterans
Benefits Administration's (VBA) work credit and management systems
deserve careful review by Congress. The VFW applauds this Subcommittee
for using its oversight authority to examine the incentives within VBA
that pit ``Quality vs. Quantity.''
Further, the VFW compliments Secretary Shinseki's leadership team
for VA's Open Government Plan. We fully support all efforts to
transform VA into a people-centric, results-driven, forward-looking
organization. We welcome every opportunity to work with Secretary
Shinseki to encourage a transparent, participatory and collaborative VA
that places veterans and their survivors at the center of every
decision.
The VFW's chief concern today is the very real perception that VA
puts more emphasis on the number of claims that are processed than the
accuracy of those claims. This is validated by VA's own measures in the
``Monday Morning Report,'' as well as by many VA Office of Inspector
General (IG) reports. Secretary Shinseki's goal of rating all claims
with 98-percent accuracy in under 125 days is extremely laudable, but
the VFW would be ecstatic if VA could just reach the 98-percent goal
with the current average wait time of 165 days.
Workload & Management Systems
Claims submitted to VA are tracked by the assignment of a discreet
identifier called an ``end product.'' VBA's work management and
measurement systems have various subsystems to track the age of each
pending end product, to track the various development and rating
actions taken in end products, and the number of end products
completed. VBA's work management system tracks all computer actions
taken on pending claims by service center employees.
In our view, the major focus for VA must be on management systems
reform and fostering a culture change in VBA. As indicated above, VBA
has management and work measurement systems that have been in place
with only minimum changes for decades. There is a systematic review of
the basis used for these management and work measurement systems being
conducted, but the results have not yet been released.
Quality Measurement
The current system employed by the Department of Veterans Affairs,
Systematic Technical Accuracy Review (STAR), to analyze and determine
accuracy in promulgated claims decisions was created and deployed in
1997. The system determines accuracy by using analytic statistics over
the previous 12 months. This is identified as a ``rolling 12'' since
each current month that is added results in dropping the oldest month.
When STAR was first used, the accuracy rate was 64 percent and is
currently 83 percent. Although there has been an increase in overall
accuracy, it is far from an acceptable standard.
The system is based on a random selection of promulgated decisions
(rating, authorization and fiduciary) under specific rating indicators
or ``end products.'' Therefore, not every decision of a claim is
subject to the review. Cases are requested from each regional office
based on size. It is very difficult to obtain a reliable sample size. A
truly representative sample for the larger offices would require many
additional reviewers. The current sample size for the ``National
Average'' in rating decisions is 13,199 cases for 57 regional offices
for the past 12 months. The current sample size for the ``National
Average'' in authorization decisions is 8,251 cases for 57 regional
offices for the past 12 months.
The system is based on the concept that a decision is either
entirely correct or entirely wrong. No longer are there classifications
of errors from mere procedural to substantial. Once an error is called
and the regional office notified, there is a time period (usually 60
days) in which the regional office may request reconsideration of the
error. It is their responsibility to ``make the case'' that the
decision was not incorrect. Since an error can be reversed within a
period of time, the accuracy rate reflects a period of time that is 3
months delayed. In other words, the report issued in early February
covers decisions ending in November 2009. This time delay affects the
validation of the numbers.
The group of employees, considered to be staff of the Compensation
and Pension Service in VA Central Office, is located in a separate
facility in Nashville, Tennessee. Each expert consultant is tasked with
a ``second look'' at cases with identified errors to insure corrective
action is completed based on the error. This is assigned on a rotating
basis as ``other duties as assigned'' and not their primary priority.
There are some deficiencies in this analysis of completed claims.
Since it is a random selection of certain types of actions, it is only
those identified actions that determine the error or accuracy rate. For
example, a claim is identified for review based on a completed action
in April 2009. That action is completed according to current policies
and regulations. However, the consultant discovers an erroneous action
taken in January 2006. The consultant has the responsibility to
identify that error and direct corrective action under a ``comment''
rather than a formal error call. That action must be completed, but
does not figure into the overall accuracy rate.
There is one big deficiency to this system that constantly presents
a major problem to VA. No one learns from their mistakes. The STAR
system was designed to enhance training and knowledge. Each regional
office is treated as an individual office and not part of a larger
quality control system. It is true that the VA ``intranet'' has links
for regional staff to review the number and type of errors being called
but there is no mandatory training of personnel. Identification of an
error without a clear instruction or resolution is of no value. Each
individual rating or authorization decision maker very rarely is
counseled on their individual quality. Therefore, they believe that
they were not responsible for any mistake. The overall accuracy rate
may be part of the performance standards for managers and directors,
but an individual employee is graded on a ``pass/fail'' standard. VA
willingly admits that production is ``job one.'' Training is the first
casualty in the war of the pending backlogs. The nature of the work has
become extremely complicated and training should be absolutely required
for all decision makers. Regular and serious training will not only
stop the slide, but will actually enhance individual skills. The
training in an open and serious environment will also benefit all VA
staff who interacts with veterans. All such training efforts should be
thoroughly documented for all interested parties.
Suggestions for Improvement
Quality must be incentivized as the primary component of all VA
workload and management systems. The current systems are self-imposed
VA models that do not have incentives built in to reward accuracy or to
correct poor decision-making. The VA must consider the individual
training needs of each employee and each regional office in all future
work-credit systems. VA leadership must be able to quickly and
accurately identify the items that need additional training on the
local level.
The current VA nationwide accuracy rate is 83 percent, which ranges
from 92 percent at the best Regional Office in Des Moines to a 67
percent worst in Baltimore. All of which still fails to achieve
Secretary Shinseki's 98-percent accuracy goal.
The VFW previously suggested that ratings quality could be improved
by instituting a two-signature review on every claim before the rating
decision is finalized. The management at the Baltimore Regional Office
recently decided to start doing two-signature reviews on all actions,
ratings and authorization. We will be watching carefully to see if this
practice improves their accuracy rate.
The VFW strongly supports partial rating decisions, thus allowing a
veteran immediate financial assistance and access to medical care,
while promoting the further development of the complete claim. However,
VA must grant work credit for partial decisions to incentivize VA
employees to utilize this practice. With the advent of an electronic
claim, individual issues will be more easily tracked. Most claims are
comprised of multiple conditions/issues. Currently, a claim cannot be
counted as a completed end product until all claimed conditions have
been addressed. Further, veterans cannot be paid until a condition or
issue is granted. With the tracking of individual issues, both work-
credit and compensation may be awarded as the claim undergoes further
development and is finally completed.
VBA leadership needs to reward quality and accuracy. VA must
examine each process and decision point and reengineer them to reduce
the opportunity for error. Make each decision more difficult to get
wrong and errors will be reduced. Regional Offices and individuals with
high quality and/or accuracy ratings should be rewarded for their work.
The VA management team should focus on changing the culture in VBA so
that quality rules, without exception. VBA should emphasize processing
an issue correctly the first time.
Finally, VA collects timeliness data to monitor the ability of
every office to complete claims within certain pre-established goals.
The VFW believes VA should share this information with new claimants
via e-mail or letter. Just as many commercial service centers inform
telephone callers that ``your call will be answered in 3 minutes,'' it
should be just as easy for VA to use real-time information on how long
it normally takes to process original compensation claims from, for
example, Montgomery, Alabama, which would be 250 days. While that is
far too long to process a claim in any world, the veteran would still
be knowledgeable of the average length of the wait.
Mr. Chairman, this concludes my testimony. I would be happy to
address any questions you or your committee may have. Thank you.
Prepared Statement of John L. Wilson, Assistant National Legislative
Director, Disabled American Veterans
Mr. Chairman and Members of the Subcommittee:
I am pleased to have this opportunity to appear before you on
behalf of the Disabled American Veterans (DAV) to address the efforts
of the Veterans Benefits Administration (VBA) to properly balance
quality and quantity in their work credit and work management programs.
Too often, VBA has attempted to manage an ever increasing workload by
emphasizing production to the detriment of accuracy. We commend this
Subcommittee and Congressman Hall for holding today's hearing which
focuses on this very important issue and how VBA's work credit and
management systems impact the claims backlog.
Let me note at the outset that in preparing for today's testimony,
we lacked some information that could have better informed our
testimony. Specifically, I am referring to the report on the work
credit and work management system required by Section 226 of Public Law
110-389, Veterans' Benefits Improvement Act of 2008, which was due to
Congress over 6 months ago. It is our understanding that the Center for
Naval Analysis (CNA) presented this report to VBA last November, but
that it has remained at the Department of Veterans Affairs (VA) for
their review and concurrence.
In addition, VBA has just recently implemented new performance
standards for Veterans Service Representatives (VSRs) that
significantly change the work credit system for employees performing
triage, development and post-development work on claims for benefits.
We understand that new performance standards for Rating Veterans
Service Representatives (RVSRs) are also due to be released shortly. We
look forward to hearing VBA's explanation for how these new standards
were developed, how they will be implemented, and what effect they will
have on both the quantity and quality of work produced by VSRs and
RVSRs.
Mr. Chairman, like you, DAV remains concerned about the large and
growing claims inventory, or backlog, that VBA is managing. However, we
caution the Subcommittee that the backlog is not the problem, nor the
root cause of the problem; rather it is a symptom. It is akin to an
individual having a fever. While one can take aspirin to reduce the
fever, unless the underlying condition that caused the fever is
treated, the fever may return and the patient's condition may worsen.
So too it is with the claims backlog. The underlying condition is a
broken claims processing system that leaves too many veterans waiting
too long for rating decisions that are too often wrong. Until we
address the root problems within that system that resulted in the
backlog--lack of quality, accuracy and consistency--no matter how
quickly claims are processed, the problems will remain and the backlog
will return.
For this reason, we believe that the best and only approach that
will work is one that emphasizes quality at every stage of production.
To achieve this outcome, it is essential that we examine the system of
incentives and accountability for employees, management and leadership.
Mr. Chairman, I am sure you and other members of this Subcommittee
have heard Secretary Shinseki say that he intends to ``break the back
of the backlog this year.'' The way this will be measured is through
VBA's Monday Morning Workload Reports which contain measures of
production, but not accuracy or quality. Since this is the only set of
numbers that consistently makes its way into the consciousness of
Congress and the media, it is not surprising that the backlog has
become the focus of each, and thus VBA's leadership has a great
incentive to reduce the backlog, which logically leads to an emphasis
on production. However, producing more inaccurate decisions will not
reduce the backlog; it will increase it and further clog the appellate
process.
Similarly, looking at VBA's Dashboard, which provides the current
performance statistics for each VA Regional Office (VARO), the measures
reported are primarily related to pending work inventory and production
times. There are few measures of accuracy included in the Dashboard
reports, and those are based upon 12-month rolling averages from
national STAR reviews. Improvements to these quality measures would
take many months to show up, whereas changes in production would be
more easily influenced by management decisions about resource and work
allocation. Given the directive from leadership to ``break the back of
the backlog,'' it is not surprising that VARO management focuses
heavily on production, rather than accuracy or quality.
Given leadership and management's focus on production, it is not
surprising that employees--VSRs and RVSRs--feel tremendous pressure to
meet production goals. While accuracy has been and remains one of the
performance standards that must be met by employees, there is reason to
believe that the work credit system creates incentives for them to
favor production over accuracy.
Performance standards are the most important factor in determining
the incentives for employees. If the standards either directly or
indirectly reward production over quality and accuracy, we must expect
employees to work first toward production goals. Although we have not
heard VBA's explanation of the new performance standards, nor seen the
CNA study on the work credit system, we were able to get a copy of the
new VSR performance standards and offer the following observations and
concerns about this significant change.
The new performance standards have streamlined the measures of
production for VSRs from what had been 63 categories of weighted work
activities to five production categories now called ``outputs.''
Essentially, a VSR will receive one ``output'' credit for completing
each stage of the work process: initial rating development, initial
nonrating development, ready for decision, process award/decision and
authorize award. It appears that this system is designed to emphasize
moving claims quickly towards completion by eliminating the piecemeal
work credits that were based upon each activity related to development
that was completed.
The new system provides no work credit for Congressional inquiries,
Freedom of Information Act requests or conducting personal interviews.
It also appears to eliminate work credit for appeals related
activities, such as supplemental statements of case (SSOC).
We have been told that the old work credit system created
opportunities for ``gaming'' the system, such as delaying requests for
routine future exams, in order to gain additional work credits.
However, we are now concerned that the new streamlined system of
measuring only ``outputs'' may inadvertently create incentives for
cutting corners, since more complex cases get no more credit than
simple cases.
In addition to output, there are three other ``Critical Elements''
in the new VSR performance standards: Quality, Timeliness, and
Training. We certainly agree that each of these are essential to
improving the benefit claims processing system; however, we do have
questions about how these new standards will produce more accurate and
timely claims.
We note that VBA has increased the accuracy standard for VSRs and
we certainly agree that accuracy, even by the national STAR measures,
remains too low. However, it is not clear how raising the standard in
and of itself will result in increased accuracy. We also remain
concerned about how reliable the employee reviews will be for measuring
quality. We have testified previously that coach reviews of five cases
per month are not accomplished 100 percent of the time, and in many
cases coaches do not have sufficient time to comprehensively review
each case. As a consequence, we do not have confidence that employees
performing below or above standard will be consistently measured.
Employees in need of extra training and individualized mentoring may
not get the attention they need to become more effective. We are also
concerned that these local quality reviews may be significantly
different from station to station.
We continue to note that VBA does not have a unified system for
aggregating and analyzing the results of both the coach reviews and the
STAR reviews in order to provide trend analysis for both quality
control improvements and for development of new training instruments.
Under the new VSR performance standards, ``Timeliness'' will be
established locally by each VARO based upon end of year station
targets. While we recognize that cycle times vary from station to
station due to workload and inventory, we question whether it is
reasonable to have employees at different stations being held to
different standards for the same work. We also have questions about
whether cycle times, which include wait periods and work volume, are
the most reasonable measure for holding VSRs accountable. For example,
is the cycle time for average days awaiting evidence a fair measure
since the submission of evidence is not in the control of the VSR?
VSRs will also now be held accountable for meeting the ``Training''
standard. We question whether this should be a management
accountability standard more than an employee standard, since training
is critical to keeping staff informed of the evolving nature of claims,
whether it is new presumptive service conditions, changes in public law
or recent Court cases. Given some reports we have heard from the field
about management pressuring employees to cut back on time for training
to meet production goals, how is management held accountable for
training being properly implemented?
Mr. Chairman, we congratulate you and the Subcommittee for holding
today's hearing raising the critical issue of quality. We will continue
to work with you and others to help create a culture at VBA that
measures and rewards the quality and accuracy of results, not just
quantity, and provides sufficient training of VA's management and
workforce in order to achieve this outcome.
That concludes my testimony and I would be happy to answer any
questions the Subcommittee may have.
Prepared Statement of Ian C. de Planque, Deputy Director,
Veterans Affairs and Rehabilitation Commission, American Legion
Mr. Chairman and Members of the Subcommittee:
I appreciate this opportunity to express the views of The American
Legion on the importance of accuracy in the veterans' benefits system.
The Department of Veterans Affairs (VA) has maintained, as stated by
Acting Undersecretary for Benefits Michael Walcoff in a January 3, 2010
appearance on CBS's 60 Minutes, that: ``We stress over and over again
to our employees that quality is our number one indicator, that that's
absolutely a requirement for successful performance.'' However, even
cursory examination of actual operations shows that a far greater
emphasis falls on the quantity of claims processed than the accuracy
with which those claims are processed. VA Secretary Shinseki has
recently set forth a bold goal of elevating the accuracy rate to 98-
percent, while slashing the time of processing those claims to a state
in which no claim would remain in the system unfinished for more than
125 days. In short, VA means to eliminate the backlog while eliminating
error. If such a thing is possible, it would obviously be of great
benefit to the veterans of America; however, if such a plan has any
chance of being effective, it must start with the quality component.
Otherwise there is little hope of providing real benefits to veterans.
Quality is essential because of the sheer scale of the matter. By
VA's own admission, in 2010 and 2011 and beyond, they will be
processing in excess of a million claims a year. With volume such as
this, even an error rate of 1 percent represents 10,000 claims
incorrectly processed. Recently, VA's most optimistic accuracy
projection was 87 percent. This number was challenged by the VA Office
of the Inspector General (VAOIG) as being highly optimistic and at
least 10 percent higher than the actual figure. However, even relying
on this inflated number, when one small component of the upcoming
claims challenge is examined, the impact is potentially staggering. VA
expects approximately 200,000 veterans with Ischemic Heart Disease to
file claims under the new regulations regarding Agent Orange in 2010.
Going by the optimistic error rate of 13 percent, this still means
26,000 of those veterans will have their claims improperly processed.
Errors at VA impact thousands of veterans every year. A veteran who
struggles to earn an income because of a service-connected disability,
an error that denies service-connection for that disability can be the
difference between getting by and becoming one of the over 100,000
homeless veterans in America today. Errors affect lives. It is
essential that the removal of errors from the system be the highest
priority of reform.
Testimony from the American Federation of Government Employees
(AFGE) representatives before this Subcommittee, as well as comments
during personal interviews conducted during American Legion Quality
Review visits to Regional Offices, has spoken of the overarching
pressure to ``make the numbers for the week''. VA employees are charged
to complete a minimum of 3.5 claims per day, often more in some
Regional Offices. This pressure leads to the conundrum faced by a VA
rater at one Regional Office who, during the interview process of an
American Legion Quality Review, gestured to a claims file five inches
thick and stated, ``That's one of my fellow veterans there. I have less
than two hours to go through that claim. How am I giving that guy
justice?'' The employees want to get the job done right. VA employees
want to take pride in their work and be accurate. They want to help
veterans. However, the pressures brought about by volume are making it
increasingly difficult for those employees to do so.
To resolve the issue, VA will have to go through a several step
process, yet none of these steps are insurmountable. VA must begin by
making quality the foundation upon which all else is based. They can
make better use of triage techniques to help manage the time
constraints that quality demands. Finally, VA must commit to accuracy
as a greater measure of success than quantity of claims processed.
VA is in the process of testing multiple pilots across the country
to determine the most effective operating procedures in their Regional
Offices. Whether it is the ``Lean Six Sigma'' pilot in Little Rock, the
electronic office pilot in Providence or one of the many others, these
pilots all have the same aim--to improve how VA operates and to create
a better system. However, even in these efforts, the goal is increased
speed in processing as the ``Prime Directive.'' Clearly, VA is
interested in transforming the office environment and thus there is no
better time to ensure that this transformation is built upon a solid
foundation--accuracy.
Quality takes time. It takes time to do something right. However,
when something is done properly in a repetitive manner, speed will
derive from the smoothness. Familiarity breeds speed. When an employee
develops speed due to quality and effectiveness, they are developing
speed with the proper procedure. As the system currently works, there
are errors rampant within the processing system. This is compounded by
tremendous pressure placed on VA by veterans' and military service
organizations; private citizens; the media; and Congress to eliminate
the backlog. Perhaps the focus should be on quality the first time and
not the backlog itself. New tools, such as electronic office measures
to operate in a paperless environment, are touted as the solution to
increase timeliness. However, unless the transformation of the
operating environment is fundamentally changed to an environment based
on quality, VA will only be processing mistake-ridden claims . . .
faster.
Ingrained in military training is a well-known maxim that ``if you
do something right, the speed will follow.'' It is the principle of
crawl, walk, run. Take the time to learn the procedure right the first
time, each successive time that the task is performed, speed can and
will be increased. The important difference is that proficiency and
speed will be increased under a proper operational model.
VA has increased hiring due to additional monies provided by
Congress. As the existing workforce is being displaced through
retirement, VA is in a position to, through training of the new
employees, create a core group that will be the foundation of VA going
forward through the 21st Century.
Taking the time to do claims correctly and inculcate this mindset
of attention to detail will, in fact, temporarily increase the existing
backlog. Some of this process may require a more sympathetic eye
towards a slower pace of reduction. Most veterans could agree that a
little longer time for a claim, if it is done properly, is a small
sacrifice to pay for a system that will be better and better for many
years to come. A little more patience is required for a job done right.
If your choices are swift, but shoddy work vs. deliberate, but accurate
work, many would vote for accuracy every time. Errors take years, not
hours, to correct.
Still, there can be improvements in the overall system that will
help create the necessary time to get the job right. In a more
efficient system, time can be better allocated to get the right amount
of time to the claims that demand additional time. With a better system
of triage, simple claims which require little or no development can be
fast-tracked, allowing for a greater portion of time to be allotted to
those claims that justifiably demand more intricate attention. VA can
identify claims, such as presumptive disorders, submitted with private
medical evidence. These claims can be granted immediately with an
interim rating, allowing for the lion's share of development time to be
undertaken after veterans are integrated into the system and receiving
their earned benefits, such as health care for their condition.
A simple claim seeking an increased rating for hearing loss, which
should require little development, can be performed in short order. If
VA seeks to maintain their present rate of three to four claims a day
per employee, triaging claims to account for simple claims that can be
accomplished relatively quickly will provide more time for those claims
that have more issues or are more complex. In this manner, the overall
numbers should continue to be relatively the same, or even improve, if
a more efficient system of directing claims to where they can be
processed most effectively can be implemented.
All of this will be in vain, however, if VA continues to track
success primarily by the number of claims processed. VA regularly
reports the number of claims processed and the number of claims pending
in their Monday morning workload reports. These reports are silent as
to the accuracy of claims being processed in the offices and in the VA
overall. This is a clear indication of what matters. Human nature
dictates that employees will work to the acceptable standards put forth
by management. If management stresses numbers, then numbers are what
employees will strive to accomplish. If management stresses accuracy
and judges employees based on accuracy, then the incentive to cut
corners will disappear, and employees will exercise more caution to
ensure they aren't falling behind in accuracy.
Similarly, if management is judged on the volume that their office
produces, and little attention is paid to the quality of work, managers
will respond with greater emphasis on volume to their employees.
Currently, there is a single component devoted to accuracy rate in
management evaluation, the greater emphasis is on performance, and
thus, whether management receives bonuses is based on the volume of
claims moved through the office. As long as this state of affairs
persists, then quantity is what will be produced, often at the expense
of quality.
The American Legion has long supported a change in the manner in
which VA counts their production. The American Legion continues to
advocate for a system that is based on quality determined by the final
adjudication of the claim. This is based on a belief that the current
emphasis on numbers creates an atmosphere of substandard quality and
cutting corners, and that, as much as any other factor, contributes to
claims remaining in the system for long periods of time, thus leading
to the backlog of claims VA is currently operating under.
The American Legion believes that the backlog is not the problem.
The backlog is merely a symptom of the problem. Much as an infection in
the body leads to a fever, the infection of poor quality work in VA
leads to the backlog. If you treat the infection, the fever will
reduce. If you improve the quality of decision-making in VA, the
backlog will diminish.
The media is full of reports of veterans who fight years and years
in the VA system for benefits they are entitled to receive. The
constant refrain from frustrated veterans is that VA is delaying and
denying and waiting for them to die. A veteran's claim is not an
initial claim, if it is languishing in the system for multiple years.
VA's average processing time for an initial claim hovers around 6
months. While many of these initial claims can exceed a year, multiyear
claims are almost exclusively claims that have been appealed through
the higher levels of VA's adjudication system.
When a claim is reviewed by the Board of Veterans Appeals (BVA)
many years after the initial claim has been filed and appealed and made
its way to Washington, DC, that claim is commonly remanded or returned
to address simple procedural errors that were made at the Regional
Office. Many of these claims are won once the proper procedure has been
followed. The end result is that a veteran with a legitimate claim has
waited now for three to 4 years or more to be granted a claim that
would have been won in the Regional Office had the Regional Office only
done its duty properly the first time.
To understand the scale of the appeals problem, it is again
important to consider the numbers involved. If VA is processing
approximately one million claims a year, and approximately 10-15
percent of veterans are appealing these claims simply because of poor
decision-making and failure to adhere to the required procedures, then
approximately 100,000--150,000 cases are being recycled into the system
every year. These are hundreds of thousands of claims that would not be
a part of the backlog had VA done the job properly when given the first
opportunity to do so.
It is this cycle which must stop if the backlog is ever to be
cured. By minimizing, or better yet eliminating errors at the Regional
Office level, the number of appeals and thus the number of claims
destined to languish many years in the system will be massively
diminished. This is the goal VA must strive for.
VA's frequency of error has created a gulf of distrust between this
Federal agency created to help veterans and the community of veterans
that they have been directed to serve. Veteran confidence in the VA's
ability to correctly process their claim is very low. However, this
trust is not lost, merely damaged, and with diligent effort on the part
of VA it can be restored. In the 1970s the Veterans' Health
Administration faced a similar lack of confidence in their ability to
serve the veterans' population. A major overhaul was required to regain
the public trust.
The American Legion monitors the VA health care system through our
annual System Worth Saving reports. What has been shown is a renewed
confidence in VA health care. Many veterans speak proudly of the care
they receive through VA and the quality of that care. Patient
satisfaction is among the very best in the entire health care industry,
public and private. There are still problems within that system, and
there is always much work to be done. However, the example of this
transformation and VHA's ability to regain some measure of trust within
the veterans' community is indicative that it is not too late for the
Veterans' Benefits Administration (VBA) to similarly embark on a great
campaign to regain the trust of the veterans that they serve.
The present administration of VA under Secretary Shinseki has set
bold expectations and shown promising signs. The candor with which they
admit to the grave flaws within the system and the necessity of change
is both refreshing and admirable. Whether or not the reality of this
transformation within VA will conform to this mission statement remains
to be seen. VA has recently announced changes to their internal work
credit system. Information on exactly what these changes constitute is
currently slim, yet hopefully will be revealed in the near future.
Whether these changes will be real changes with a chance to positively
support an emphasis on quality or simply window-dressing covering a
continued emphasis on pure volume remains to be seen.
With the positive mission laid out by Secretary Shinseki, perhaps a
situation of distrust may be moved to one of ``trust, but verify''.
There is, to be sure, a great deal of damage that has been done to the
state of trust by an ongoing culture of volume over accuracy. When
veterans look to the system designed to support them, they too often
experience only a cold, unfeeling bureaucracy that treats them as a
number and pays little attention to getting their claim done ``right''.
If a mistake is made, then what are the consequences? Veterans do not
see consequences for errors, but experience the dramatic impact on
their life and well being. This must change.
VA stands on the brink of a major transformational effort. There is
no better time than the present to rebuild this system on a bedrock of
quality and accuracy. There is no better time to repair the lost trust
with the veterans' community. A demonstrable dedication to quality
above all else would go a long way towards doing so.
The American Legion stands ready to answer any questions of this
Subcommittee and thanks you again for this opportunity to provide
testimony on behalf of our members.
Prepared Statement of Jimmy F. Sims, Jr., Rating Veterans Service
Representative, Winston-Salem, NC, Regional Office,
Veterans Benefits Administration, and Shop Steward, Local 1738,
American Federation of Government Employees (AFL-CIO), and
AFGE National Veterans Affairs Council
Chairman Hall, Ranking Member Lamborn and Members of the
Subcommittee:
Thank you for the opportunity to share the perspective of the
American Federation of Government Employees (AFGE) and the National
Veterans Affairs Council (VA Council), the exclusive representatives of
Compensation and Pension Service (C&P) employees of the Veterans
Benefits Administration (VBA), regarding the critical need to overhaul
the current work credit and work management systems.
The work credit system is the essential building block for managing
work and evaluating performance. This system must be developed on the
basis of valid empirical data; VBA must, with no preconceptions,
identify how much an employee can reasonably be expected to do with an
acceptable level of accuracy, and use that data to project the number
of employees it needs to process its inventory.
The studies that form the basis of work credit systems are widely
used in industry to increase productivity and known by terms such as
``business efficiency'' or ``time and motion'' studies. AFGE and the VA
Council are aware of only one extremely limited attempt by VBA to
conduct a study along these lines but it failed to produce any useful
findings. Management placed a software program on a sampling of
employees' computers in an undetermined number of ROs, with no
explanation of how they selected the sample. The data was collected by
a program appearing on the screen every few hours to ask what the
employee was doing. The program did not differentiate between employees
working on a single claim and multiple claims, thereby leading VBA to
continue to create flawed work credit and work management systems based
on incomplete data retrieved.
A study of VBA's work credit and work management systems was
mandated by P.L.110-389, but we fear that when completed by the
contractor, this long overdue study will not produce adequate data. It
is very troubling that once again, VBA did not solicit input from
employee representatives.
The performance standards that comprise the work management system
are only as good as the underlying work credit system. Pursuant to an
agreement between VBA and AFGE and the VA Council, national performance
standards to boost VSR productivity were put in place in 1997, and were
later revised in 2003, again in 2005, and most recently this spring.
AFGE and the VA Council have long taken the position that VBA is
contractually barred from raising local production standards above the
national standards. VBA's insistence on allowing ROs to set their own
local standards has led to harmful inconsistencies and low morale. For
example, a RVSR assigned to the Seattle Regional Office may be required
to produce 5.25 weighted cases per day, where a RVSR assigned to the
Winston Salem Regional Office may be required to produce 4.0 weighted
cases. Consequently, RVSRs in Seattle have to complete 6 single
weighted action cases, while RVSRs in Winston-Salem only have to
complete 4 cases, to meet the local standard.
The underlying problem is that production standards for VSRs and
RVSRs appear to be based more on politics and bonuses rather than on
the goal of processing today's complex claims in an accurate and
complete manner. VBA managers, many of whom have not adjudicated a
claim for many years (or never), define performance largely in terms of
inventory and days pending completion of a decision. Our members
working on the front lines report that when they meet RO production
goals, they have been ``rewarded'' with arbitrary increases in
production standards for the following year.
VBA has not adjusted individual employee production standards to
reflect the increasing sophistication of our claimants, the complexity
of claims and continued changes stipulated by regulation. Employees are
subjected to arbitrary and unreasonable production standards that lead
to inefficient and incomplete claims development. As a result, issues
are missed, evidence is ignored, and decisions are rushed. All of this
results in poor service to our claimants and is contrary to the VA's
mission.
The current standards discourage complete and accurate claims
development by denying employees credit for completing work on
essential tasks. The following are some of the many examples of
essential work that VSRs and RVSRs perform for which they receive zero
credit: (We can provide more examples at your request)
1. VSRs receive zero credit for Triage and Public Contact work
because the new VSR Performance Standards only allow credit based on 5
criteria (instead of 60);
2. RVSRs get zero credit for additional development directed or
completion of VA examination requests, even though both may require
multiple hours of production time to complete;
3. Under the previous standards, VSR would receive full credit for
all tasks (``End Products (EP)''). Under the current VSR standards,
employees can receive zero credit for work completed. For example, a
VSR on the Post-determination team receives a rating to promulgate a
reopened claim (EP 020), and the veteran requests to add a dependent
(EP 130). In addition, VBA proposes to reduce the rating of one of the
veteran's service-connected disabilities (EP 600). The employee would
only receive credit for the 020, while completing the other actions for
zero work credit.
4. VSRs get zero credit for any supplemental development, i.e. all
aspects of the claim following initial development actions at the time
the claim is established. The only other credit is applied at the time
the claim is established as Ready for Decision. For example, RVSRs may
send the case back to ``cut'' (request) the correct exam. (This is
occurring more frequently because VSRs are being asked to write opinion
exams and perform other complex work without adequate training, thus
causing more requests for the wrong exams). In this case, the VSR is
forced to remove any prior credit taken, and must complete the directed
development with zero credit given.
5. In order to provide medical release forms to all treating
physicians, VSRs may spend up to an hour--with zero credit--duplicating
individual release forms, because veterans often erroneously list all
their providers on a single form.
6. VSRs and RVSRs get zero credit for the mandatory work of
reviewing the claims folder, which may take as long as two to four
hours to complete.
Other Concerns
The current work credit system fails to adequately measure the work
of VBA personnel who have been assigned collateral duties (in addition
to adjudication duties), e.g. Homeless Veteran Coordinator and
Seriously Disabled Veteran Coordinator. These employees are especially
impacted by management's continual change in priorities to meet new
Central Office mandates.
Similarly, employees assigned to outreach duties during the work
day do not receive adjustments in their work credit for time away from
production.
New VSRs and RVSRs still undergoing training are held to
unrealistic standards and penalized for having to correct prior work,
regardless of how much time this takes away from production.
Corrections are not considered in the evaluation of performance.
Summary
The current work credit system has created a tremendously
stressful, demoralizing, assembly-line work environment that is hurting
VBA retention of experienced employees and contributing to attrition
among new hires. The current system also takes a heavy toll on
training, resulting in the termination of many employees within the
first year. The ultimate harm falls upon the veterans, who are deprived
of a full, fair, and timely consideration of their claims, and a
growing backlog.
Therefore, AFGE and the VA Council urge the Subcommittee to mandate
a scientific time-motion study of the resources and skills required to
do the current mix of increasingly complex claims. Both VSOs and
employee representatives should have formalized, ongoing roles in the
design, implementation and updating of the new work credit and work
management systems, as well as staffing decisions based on these
measures. Thank you.
Prepared Statement of Diana M. Rubens, Associate Deputy Under
Secretary for Field Operations, Veterans Benefits Administration,
U.S. Department of Veterans Affairs
Mr. Chairman and Members of the Subcommittee, thank you for
providing me the opportunity to appear before you today to discuss the
Veterans Benefits Administration's (VBA) work credit and work
management systems as they relate to quality, accountability, and
accuracy in compensation and pension claims processing. I am happy to
be accompanied by Jason McClellan, Director of the Veterans Benefit
Administration's (VBA) Central Area Office. VBA acknowledges the
concerns of our Veterans, stakeholders, and the general public
regarding our current work credit system and the perceived emphasis of
quantity rather than quality; however, VBA does not and never has
emphasized the quantity of claims completed over the quality of our
decisions.
Under the leadership of Secretary Shinseki, the vision of VBA and
that of the entire Department is to be an advocate for Veterans, not an
adversary. Secretary Shinseki's guidance to VBA and all of VA is clear:
to transform VA into a 21st Century organization and to ensure that we
provide timely access to benefits and high quality care to our Veterans
over their lifetimes, from the day they take their oaths of allegiance
until the day they are laid to rest. One of the Secretary's key
objectives is to eliminate the disability claims backlog by 2015 while
creating a new claims processing system that is more timely and
accurate. The Secretary set a goal for VBA to process disability claims
at a rate sufficient to avoid any Veteran waiting more than 125 days
for a quality review and decision. It will take all of VA, as well as
the help of Congress, Veterans Service Organizations, and other
stakeholders to achieve this goal. A crucial component of achieving
this goal is a well-trained, well-managed, and well-resourced workforce
that has the tools and systems in place to tackle the complex work of
disability claims processing. The President's 2011 budget fully
supports our progress with a 27 percent increase in VBA funding over
the current year.
As the Subcommittee is well aware, under Section 226 of Public Law
110-389, Congress required the Secretary to initiate a study of the
effectiveness of the VBA's employee work credit and work management
systems to evaluate more effective means of improving disability claims
processing performance. A report to Congress on that study was due on
October 31, 2009. I want to apologize to the Subcommittee for this late
report, which we expect to deliver in the near future.
Under a contract with the VBA, the Center for Naval Analyses (CNA)
conducted this study and produced the report titled, Qualitative
Analysis of VBA Employee Work Credit and Work Management Systems. The
CNA report was primarily a qualitative analysis of employee interviews,
and the recommendations provided focus on improving the employee work
credit system by establishing specific standards with clearly defined
actions and time allotments that support quality work. The CNA
recommendations closely align with VBA's current initiatives to better
link performance with the completion of decisions for Veterans and
lessen emphasis on discrete work actions within the claims processing
lifecycle.
I want to emphasize that VBA strives to ensure that compensation
and pension benefits are provided in a timely, accurate, and consistent
manner. As our workload continues to grow, we are committed to
increasing the consistency and accuracy of our decisions while
completing an anticipated record 1,000,000 claims in fiscal year 2010.
Regional Office (RO) performance varies as the result of several
factors including workforce experience, local economic and employment
environment, and staff turnover. VBA aggressively monitors RO
performance and develops specific action plans to address areas for
improvement. Leadership within the Compensation and Pension Service as
well as Area Directors oversee RO performance through monitoring and
site visits. Lessons learned and specific examples of ``best
practices'' from these visits are provided to assist ROs in enhancing
their performance.
As VBA's workload continues to increase, maintaining balance
between the quality and quantity of claims completed remains a
priority. VBA experienced a 14.1 percent increase in annual claims
received in 2009, and we project increases of 13.1 percent and 11.3
percent in 2010 and 2011, respectively. In addition, on October 13,
2009, Secretary Shinseki announced his decision to establish
presumptions of service-connection for Vietnam Veterans with three
specific illnesses based on the latest evidence of an association with
exposure to herbicides including Agent Orange. To respond to this
expected growth in claims receipts, Secretary Shinseki announced an
aggressive new initiative in March, 2010 to solicit private-sector
input on a proposed ``fast track'' Veterans' claims process for these
new claims related to Agent Orange exposure during the Vietnam War. We
are seeking automated solutions for the parts of the claims process
that take the longest amount of time but do not involve actual
adjudication or award of benefits. VA believes these parts of the
process can be collected in a more streamlined and accurate way. With
this new approach, VA expects to shorten the time it takes to gather
evidence, which now takes on average over 90 days. Once the claim is
fully developed and all pertinent information is gathered, VA will be
able to more quickly decide the claim.
VBA has both short-term and long-term strategies underway to reduce
the backlog of disability claims while improving the quality of our
output, even as those claims increase in number and complexity. VBA
continues to aggressively hire claims processing staff across the
Nation. Recognizing that it takes approximately 2 years for a new
employee to become fully trained in claims processing, ROs are
encouraged to implement mentoring programs and provide new claims
processing employees with timely feedback from trainers, reviewers, and
supervisors. Area offices are increasing their oversight of ROs whose
national rating-related claims quality is below 85 percent. In
addition, quality factors heavily into VBA's three-tiered incentive
compensation program which provides meaningful incentives to ROs that
achieve a 90 percent or higher accuracy rate for the fiscal year. As
mentioned earlier, an expanded workforce, improved training and
leadership are a part of the toolkit we are bringing together with new
technology and business systems solutions to tackle the disability
claims backlog. No single part of this approach can solve the
disability claims backlog alone. It must be a concerted approach,
throughout the entire VA, to bring every tool to bear on this important
priority.
Completing an independent VBA effort begun in 2009, we recently
revised the Veterans Service Representative (VSR) performance standards
in ways that address recommendations since made by CNA. VBA performance
standards have always included a quality element for claims processors
to ensure correct information is disseminated and accurate decisions
are provided on all claims administered by the VA.
The newly revised VSR performance standards further align
individual employee performance targets with national targets and
require local quality reviews to be based on the same criteria as the
national quality assurance reviews. In developing these new standards,
VBA formed a workgroup of subject matter experts from all levels of the
organization, including RO Directors, Veterans Service Center managers,
and first-line supervisors, as well as employees from the Compensation
and Pension Service and the Office of Field Operations in VBA
Headquarters. A VSR also participated in the workgroup as the
representative for VBA's labor partner, the American Federation of
Government Employees.
VBA implemented the revised performance plan for VSRs nationwide on
April 12, 2010. The revised plan aligns the specific quality and
production elements with the national targets, allowing performance
credit only for those actions that advance a claim to the next stage of
a claim's life cycle. A similar initiative is currently underway for
the Rating Veterans Service Representative and Decision Review Officer
performance plans.
VBA is actively pursuing additional initiatives to reach our
strategic goals of eliminating the backlog of disability claims while
achieving a 98-percent quality level. We established pilot initiatives
to improve claims processing and services to Veterans at the Little
Rock, Providence, and Pittsburgh ROs. These pilots are actively
exploring process and policy simplification and technology improvements
to enable VBA to reach our goal of providing world-class service to our
Veterans. The CNA study also looked at the current VA work management
system, referred to as the Claims Process Improvement Model, which
emphasized employee task specialization. In support of the pilot in the
Little Rock RO, VA has engaged Booz, Allen, and Hamilton to assist with
evaluating the current claims process using lean six sigma analysis
techniques.
This past fall, VA employees and co-located Veterans Service
Organizations submitted more than 3,000 ideas as part of a VA
Innovation Initiative competition with the stated purpose of finding
the best ideas to improve the claims process. Ten winners were
announced; after further analysis, eight were determined to be viable
solutions. We are working with the ROs that submitted these initiatives
to refine costs, timelines, and resource requirements for
implementation.
In addition, VBA Leadership met for a week in March to begin to
develop a comprehensive plan that will focus on eight lines of action
for change in VBA in order to achieve the Secretary's goal of
eliminating the disability claims backlog by 2015. These lines of
action include: leadership and culture, performance management,
resource capacity and footprint, process design, claims segmentation,
Veteran partnership, legislative and regulatory framework, and
technology.
Developing and implementing these technological and procedural
initiatives will reduce the time required to obtain information from
outside sources, simplify the claims adjudication process, and increase
accountability for claims decisions. These changes will help us achieve
our goals of eliminating the disability claims backlog, reducing the
pending inventory, fielding a sustainable processing system where
significant inventories do not develop, and most importantly, providing
all Veterans with accurate, timely, and consistent decisions on their
disability claims.
Mr. Chairman, this concludes my statement. I would be happy to
respond to any questions from you or other Members of the Subcommittee.