[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
AN EXAMINATION OF POORLY PERFORMING
U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICES
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
FIRST SESSION
__________
JUNE 2, 2011
__________
Serial No. 112-16
Printed for the use of the Committee on Veterans' Affairs
_____
U.S. GOVERNMENT PRINTING OFFICE
67-191 WASHINGTON : 2011
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC
area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC
20402-0001
COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
CLIFF STEARNS, Florida BOB FILNER, California, Ranking
DOUG LAMBORN, Colorado CORRINE BROWN, Florida
GUS M. BILIRAKIS, Florida SILVESTRE REYES, Texas
DAVID P. ROE, Tennessee MICHAEL H. MICHAUD, Maine
MARLIN A. STUTZMAN, Indiana LINDA T. SANCHEZ, California
BILL FLORES, Texas BRUCE L. BRALEY, Iowa
BILL JOHNSON, Ohio JERRY McNERNEY, California
JEFF DENHAM, California JOE DONNELLY, Indiana
JON RUNYAN, New Jersey TIMOTHY J. WALZ, Minnesota
DAN BENISHEK, Michigan JOHN BARROW, Georgia
ANN MARIE BUERKLE, New York RUSS CARNAHAN, Missouri
TIM HUELSKAMP, Kansas
Vacancy
Vacancy
Helen W. Tolar, Staff Director and Chief Counsel
______
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
JON RUNYAN, New Jersey, Chairman
DOUG LAMBORN, Colorado JERRY McNERNEY, California,
ANN MARIE BUERKLE, New York Ranking
MARLIN A. STUTZMAN, Indiana JOHN BARROW, Georgia
Vacancy MICHAEL H. MICHAUD, Maine
TIMOTHY J. WALZ, Minnesota
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
__________
June 2, 2011
Page
An Examination of Poorly Performing U.S. Department of Veterans
Affairs Regional Offices....................................... 1
OPENING STATEMENTS
Chairman Jon Runyan.............................................. 1
Prepared statement of Chairman Runyan........................ 36
Hon. Jerry McNerney, Ranking Democratic Member................... 2
Prepared statement of Congressman McNerney................... 37
WITNESSES
U.S. Department of Veterans Affairs:
Belinda J. Finn, Assistant Inspector General for Audits and
Evaluations Office of Inspector General...................... 3
Prepared statement of Ms. Finn............................. 38
Diana M. Rubens, Deputy Under Secretary for Field Operations,
Veterans Benefits Administration, U.S. Department of Veterans
Affairs...................................................... 27
Prepared statement of Ms. Rubens........................... 59
______
American Federation of Government Employees, AFL-CIO, James R.
Swartz, Jr., Decision Review Officer, Cleveland Veterans
Benefits Administration Regional Office, and President, AFGE
Local 2823, and the AFGE National Veterans Affairs Council..... 17
Prepared statement of Mr. Swartz............................. 56
American Legion, Ian de Planque, Deputy Director, National
Legislative Commission......................................... 13
Prepared statement of Mr. de Planque......................... 48
National Organization of Veterans' Advocates, Inc., Richard Paul
Cohen, Esq., Executive Director................................ 15
Prepared statement of Mr. Cohen.............................. 53
Veterans of Foreign Wars of the United States, Gerald T. Manar,
Deputy Director, National Veterans Service..................... 12
Prepared statement of Mr. Manar.............................. 44
AN EXAMINATION OF POORLY PERFORMING
U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICES
----------
THURSDAY, JUNE 2, 2011
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 2:05 p.m., in
Room 334, Cannon House Office Building, Hon. Jon Runyan
[Chairman of the Subcommittee] presiding.
Present: Representatives Runyan, Buerkle, Stutzman, and
McNerney.
OPENING STATEMENT OF CHAIRMAN RUNYAN
Mr. Runyan. Good afternoon and welcome. This oversight
hearing of the Subcommittee on Disability Assistance and
Memorial Affairs will now come to order. We are here today to
examine how to improve the under-performing regional offices.
One of the challenges facing our Nation's veterans is the
current backlog of claims for disability benefits. As of May
31, 2011, there are over 809,000 claims for disability benefits
pending rating at the U.S. Department of Veterans Affairs (VA)
regional offices (ROs). Of this amount, almost 60 percent have
languished past the strategic target of completing claims in
125 days. The President's fiscal year 2012 budget projects that
the average days to complete a claim will rise from 165 days in
fiscal year 2010 to 230 days in fiscal year 2012. The data show
that while VA is producing more claims decisions than ever
before, they are clearly not able to keep up with the demand.
Congress is unable to truly understand the makeup of these
809,000 claims and reasons why so many of them take so long to
be adjudicated correctly.
Therefore, I soon will be requesting that the VA Office of
Inspector General (OIG) direct the benefit inspection division
to compile copies of the 100 oldest claims awaiting
adjudication at VA regional offices, and conduct a review of
these claims. I will also ask that this Subcommittee be
provided with a detailed analysis of the types of issues that
are claimed in these files and the average age of the claim,
the average age of the claimant and other characteristics of
these claims, such as which regional office they were
processed. I am hopeful that this analysis will allow the
Subcommittee to better understand why these claims have been in
the backlog as long as they have and how the processing of
these claims might be improved. In addition to seeking answers
by identifying trends in these types of cases that have
lingered so long past any reasonable period of adjudication,
this Subcommittee is looking at VA employee performance and
lack of consistency in quality rating decisions between
regional offices that have been noted, and prior OIG reports.
We plan to attack this from several different perspectives.
Today we will focus on underperforming regional offices. In a
future hearing, I anticipate examining the training of VA
employees in claims processing. As a former professional
athlete, I have an understanding and respect for a healthy
competition. It is one of many tools for measuring and
encouraging peak performance by all. There are regional offices
that consistently rank in the top tier of performance metrics
and customer satisfaction.
We commend and salute those offices for consistently giving
their best on behalf of the veterans they are serving. Our
veterans who have given so much deserve no less. Competitive
comparison can also quickly identify chronically poor
performers. There may be many explanations for this
underperformance, from lack of training and inadequate
resources or even poor management. But regardless of the
explanation, the failures of these offices are unacceptable.
While there are a few bad employees that contribute to these
mistakes, I believe that many more are good employees trapped
in a system that makes things difficult. When our regional
offices fail, those who suffer are veterans served by that
office. Heroes in need should not be denied or delayed often
for many years, because of the happenstance of where the claim
was filed. This is unacceptable and must end. Last month I
introduced a bill intended to address this problem and received
some very good input at a legislative hearing from the VA and
several of the veterans service organizations (VSOs) on ways to
improve upon the national ideas in that bill.
I welcome today's witnesses to continue that discussion and
offer their own specific recommendations on how to fix the
problem of consistency in underperforming regional offices. I
would now like to call on the Ranking Member, Mr. McNerney, for
any opening statement he would have.
[The prepared statement of Chairman Runyan appears on p.
36.]
OPENING STATEMENT OF HON. JERRY MCNERNEY
Mr. McNerney. Well, thank you, Mr. Chairman. I think it is
a great idea to continue to look into how the backlog can be
reduced. The stated purpose of the hearing today is to examine
the VA's poorly performing regional offices, and this continues
the Subcommittee's efforts from the 110th and 111th Congresses
to analyze the various elements in the compensation and pension
claims process, to improve performance of the system as a
whole, and to ensure accurate and accountable claims outcomes
for our veterans. Everyone wants to see the claims backlog
reduced. I have spoken to the Secretary about it. So we want to
work together as a team to find the ways forward on this and
use the money that we are given to do this in the most
effective way.
I have to say, since 2007, the Veterans Benefits
Administration (VBA) has added over 10,000 claims processing
personnel and Congress has funded these requests. And yet, the
backlog still continues to grow. So that tells you that just
adding people is not necessarily the answer. We have to look at
the system as a whole, find out what the choke points are, and
move forward in a way that addresses those choke points and
uses the money wisely. So that is what I am going to continue
to look for. I will turn it back over to the Chairman.
[The prepared statement of Congressman McNerney appears on
p. 37.]
Mr. Runyan. I thank my colleague from California for that.
I know we are kind of thin up here on the dais on the panel
today. There are several things going on and being pushed back
by some votes. I appreciate all of your patience and sticking
around for that. Now we are going to call up panel one, witness
is Ms. Belinda Finn, Assistant Inspector General for Audits and
Evaluations with the VA OIG. She is accompanied by Mr. Brent
Arronte, Director of the Bay Pines Benefits Inspection Division
for the VA Inspector General. Mrs. Finn, your complete written
statement will be entered into the hearing record, and I now
recognize you for 5 minutes for your statement.
STATEMENT OF BELINDA J. FINN, ASSISTANT INSPECTOR GENERAL FOR
AUDITS AND EVALUATIONS, OFFICE OF INSPECTOR GENERAL, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY BRENT ARRONTE,
DIRECTOR, BENEFITS INSPECTION DIVISION, BAY PINES, FL, OFFICE
OF INSPECTOR GENERAL, U.S. DEPARTMENT OF VETERANS AFFAIRS
Ms. Finn. Thank you, sir. Chairman Runyan and Ranking
Member McNerney, thank you for the opportunity to be here today
to discuss the OIG's oversight of VA's Regional Offices. Mr.
Brent Arronte, Director of our Benefits Inspection Division in
Bay Pines, Florida is also with me today. Our testimony
summarizes systemic issues resulting from our recent
inspections and audits. VBA faces challenges in improving the
accuracy and timeliness of disability claims decisions and
maintaining efficient regional office operations. From our
inspections of 16 regional offices conducted between April 2009
and September 2010, we projected that VBA did not correctly
process 23 percent of approximately 45,000 disability
compensation claims. In these 16 offices, the Jackson regional
office had the highest level of overall compliance, at 70
percent, with VBA policy, while the Anchorage and Baltimore
offices had the lowest at 7 percent. We recommended that
Regional Office Directors enhance policy guidance, compliance
oversight, workload management, training and supervisory
reviews to improve claims processing and regional office
operations. The Directors agreed with all of our
recommendations for improvement. Our review showed processing
of temporary 100-percent disability evaluations had the highest
error rate at 82 percent. These errors happened when staff did
not follow policy and schedule future re-examinations in the
electronic system. In a nationwide audit of these 100-percent
disability evaluations, we projected that VBA's failure to
timely address the deficiencies could result in about $1.1
billion in overpayments to veterans over the next 5 years.
Errors in traumatic brain injury (TBI) claims were second
highest at 19 percent. These errors resulted from medical
examination reports that did not contain adequate information
to determine the disability claim rating. We saw improved
accuracy in processing for post-traumatic stress disorder
(PTSD) claims after VA relaxed the rules regarding the stressor
verification. This change reduced the claim processing errors
in PTSD from 13 percent to about 5 percent. We also identified
a number of problems in management areas that support
disability claims processing. For example, the regional office
employees exceeded VBA's 7-day standard by taking an average of
32 days to control claims-related mail. About 75 percent of the
regional offices inspected did not process incoming mail
according to policy. The employees also delayed making final
competency determinations for approximately one-third of
incompetent beneficiaries and did not always timely appoint
fiduciaries. Seven regional offices did not always correct
claims processing errors, identified by VBA's Systematic
Technical Accuracy Review (STAR) program. And regional office
management did not always timely complete systematic analyses
of operations that are intended to identify existing or
potential problems and propose corrective actions in
operations. We will continue our work to identify improvements
in benefits delivery during our future regional office
inspections and nationwide audits.
For example, in fiscal year 2012, we will begin an audit of
VA's efforts to develop and implement the next phase of the
Veterans Benefits Management System (VBMS), which is intended
to facilitate paperless claims processing and integrate mission
critical applications. Additionally, our benefits inspection
program will continue to review temporary 100-percent
evaluations and traumatic brain injury claims. We also plan to
add a review of VBA's homeless veterans program and continue
our work in herbicide-related disabilities.
Mr. Chairman, thank you again for the opportunity to be
here today. Mr. Arronte and I would be pleased to answer any
questions that you or any other Members may have.
[The prepared statement of Ms. Finn appears on p. 38.].
Mr. Runyan. First of all, thank you for being here and
thank you for your testimony. I heard Mr. McNerney sigh at a
few of the statistics while you were reading them out and it is
shocking. With that, I guess it is going to be more of a frank
conversation with Mr. McNerney and myself being up here and
really trying to figure out what we can do. We all know there
are problems. And like I said in my opening statement, it is
the ideas and how we are going to fix the problems that I think
are lacking a lot of times. And we do need ideas to implement
and to make into legislation. I look forward to your input
along with the other panels as we move forward. So with that,
we are going to begin questioning.
I was just curious, Mrs. Finn, as you described
characteristics of the lower ranked regional office, that don't
perform as well; are there any similar characteristics that
they all share?
Ms. Finn. We see some characteristics. Before I address the
specifics of your question, I would like to note that at some
level, all of the regional offices have performance issues. As
you said earlier, none of them are meeting the strategic
targets for timeliness and accuracy, so when we say an office
is underperforming it is basically a matter of degree as to how
their performance ranks against others. When we looked at the
timeliness of claims 2 years ago and as we looked at claims
that were over 365 days old, we noted that a lot of, regional
offices did not have efficient workload management plans, and
also that the individual performance goals weren't linked to
national targets related to claims processing. What we mean by
that is, although they may have had a total target of 125 days,
it wasn't broken down into increments that could be more easily
managed. Further, we continue to find that management and
supervisors struggle with ensuring the employees follow
policies and procedures.
We think this could be attributed to a lack of training,
need for better guidance and better supervisory oversight
procedures. We have often found that the regional offices have
not necessarily implemented policy or didn't enforce policy.
Further, they didn't do the quality reviews which is back to
the supervisory issue.
And finally, we have correlation, we believe, between
management vacancies and the performance of regional offices.
In several instances, we have seen prolonged vacancies in
offices that seem to really struggle to perform and rate claims
correctly. Since we have only completed 16 regional office
inspections for our roll-up report, we didn't make a
recommendation on this yet. We are continuing to follow that
trend to see how this plays out over the longer term.
Mr. Runyan. In any of the instances you have been through,
as you are saying we have the ultimate goal, ``the big goal,''
but we don't have the steps. Are there any specific regional
offices out there that have implemented something like that, or
they are just sticking to the big picture?
Ms. Finn. I would like to ask Mr. Arronte to address that
because he has been actually on the ground in these offices.
Mr. Arronte. Yes, sir. Primarily what we see is the
regional offices are supposed to follow national policy and to
some extent, some of the regional offices have special missions
so they are allowed to develop some local policies to meet that
mission. But for the most part, the regional offices follow
national policy to process the claims or to manage their
service centers.
Mr. Runyan. Well, I think the issue is that we are not
following the policy.
Mr. Arronte. That is correct, but what they attempt to do
is to follow the national policy.
Mr. Runyan. And I think going through this process, have
you, through your experience in the investigation, found any
disciplinary action in that realm to get people motivated? I
mean, I kind of said it in my opening statement. I know I have
gotten some pushback from some of the other VSOs before just
talking about competition.
I know human nature is to be comfortable in your spot and
not worried about competition. But a lot of time, that drives
and motivates people, and so does discipline and fear of losing
your job.
Mr. Arronte. Sure. Accountability to perform your mission,
regardless of what your job is key. We don't specifically go
out to look in these regional offices to see if punishment has
been taken or administrative action has been taken. I can tell
you at three of the offices, after our inspection results were
made available to the Regional Office Directors, some staff did
receive disciplinary action.
Mr. Runyan. Okay. I appreciate that. With that, my 5
minutes is almost up, so I will yield to Mr. McNerney for 5
minutes.
Mr. McNerney. Thank you, Mr. Chairman. You do realize the
Chairman can take more than 5 minutes when he wants.
Mr. Runyan. I will have a second round.
Mr. McNerney. I am going to focus on the quality issue. I
think that is really a key to getting where we need to go. You
know, when DeLorean was in charge of producing cars, he had the
highest output of any car manufacturer in the world. But a
large number of those cars had to be recalled and it didn't
really help the bottom line any. So putting out a large number
of claims and adjudicating them, if they have to come back, we
are not gaining anything.
So I think if we focus on the quality, we really have to
balance the quality versus the production. In surveying
stakeholders concerning VBA's employee work credit system, some
central issues raised concluded that the system emphasizes
quantity over quality. Production standards are not based on
careful analysis of the tasks performed, and work credits and
production standards do not reflect changes in the claim
complexity. Do you have any inputs on those conclusions? Does
that pretty much agree with what you understand?
Ms. Finn. We definitely see a production mentality in the
offices, and we hear employees talk about the pressure of the
production environment. Brent has firsthand experience working
in an RO, so I think he probably can add some thoughts to that.
Mr. Arronte. What we see when we go out to these regional
offices is, and to kind of piggyback off my answer that I gave
you about disciplining staff, I think that is the exception
that you find staff that are apathetic or that do not care
about their mission. I think for the most part, what we see is
people do care and the employees do want to do well, and they
want to serve veterans. I think what they are frustrated over
is the voluminous policies that VBA has, the backlog, and the
production environment. And some interviews that we have
performed with regional office staff, they tell us that they
get so frustrated that they have to put out so many widgets,
but the quality of those widgets appear to take the back seat,
and that seems to frustrate the staff, I think, more than
anything.
Mr. McNerney. So the work credit system is kind of at the
base of this, right? What do VA employees get credit for? Do
they get credit for putting out a lot of claims?
Mr. Arronte. Right. It depends on which team in the process
that they are assigned to. They have a work credit system to
meet production. They have a personal production goal where,
say, a rating specialist in one office, has to complete five
disability decisions a day. But if every rating specialist in
the regional office, let's just say there was 20 and they had
to do five per day, if they all did five per day, that would
still not make a dent in the backlog.
So when Ms. Finn said these are not tied to performance
goals, they are not tied to the overall performance goals. They
are more individual goals.
Mr. McNerney. And moreover, the five-per-day goal doesn't
necessarily reflect the complexity of the claims because the
complexity varies from claim to claim. I mean, there has to be
some way to not only have a numerical goal but a goal that
includes complexity of claims and quality of output.
Mr. Arronte. Well, I think the quality is the key, because
typically what they do is if a claim has one to seven issues
you get one credit for rating that claim or making a final
decision. But if that claim has eight or more issues, then they
get more credit because it is a more complex claim. But the
issue, I think, is the quality. And when Ms. Finn talked about
supervisors or first line supervisors not performing quality
reviews, when we speak to these first line supervisors they are
inundated with the amount of work that they have to review.
They consistently tell us that they are mandated to review five
claims per person to ensure that these are quality claims. But
five out of 500 is not material. So the emphasis on quality
doesn't appear to be as much as the emphasis on let's get the
inventory down, and the way we get the inventory down is to put
out claims.
Mr. McNerney. Does the Chairman intend to have another
round on this panel?
Mr. Runyan. You can proceed if you want to.
Mr. McNerney. Okay. Well, another question related to
management and prolonged management vacancies. My understanding
is there is a clear correlation between the quality of the
output and management being present. And what I want to ask
you, if you can verify that, is what is the reason for such a
large vacancy record of some of these ROs?
Ms. Finn. Sir, I am sorry. I would not feel that I could
give you accurate information on the reason for the vacancies.
We can speak to the length of the vacancies and some of the
circumstances, but I believe Ms. Rubens may be better able to
address the reason for why some of the vacancies have
continued.
Mr. McNerney. Okay. But you can affirm that there is a
strong correlation between the quality and the presence of
management oversight?
Ms. Finn. From what we have seen, yes, we believe there is
a strong correlation.
Mr. McNerney. So one of the ways we can improve the quality
is to make sure that management is present in these ROs, from
your point of view?
Ms. Finn. We believe so, yes. It is not just having the
manager available, it is making sure the manager is equipped
with the skills and tools they need to do the job. Sometimes,
not just in VBA, but many organizations may promote good
technicians to be a manager, and that is not always the best
manager. That person needs training and perhaps mentoring to
learn the skills required to be a good manager and not just a
good technician.
Mr. McNerney. Okay. Thank you. I yield.
Mr. Runyan. Thank you. Going back and kind of revisiting
quality, it seems that it is the quality issue that is lacking
weight in the metric and the measuring of what we are doing.
Obviously, the lack of quality directly correlates to the
backlog because then we are in, to use a phrase we use around
here, ``the hamster wheel'' again. Do you have that sense when
you look at this stuff that it is not weighted as heavily as
the output?
Mr. Arronte. Yes. It appears not to be weighted as heavily.
Even the staff, like I said, they are frustrated that they have
to continue to push out numbers. There is a quality standard,
but supervisors can only review so many. One of the issues is
span of control for the supervisors. The standard span of
control is four to six people for a supervisor. Some of these
supervisors are managing 15 to 20 people. And they just can't
physically get around and review enough claims for quality and
then perform the rest of their missions as well.
Mr. Runyan. And there is, Ms. Finn, regarding misplacing
loss claim folders, you said in your written statement this is
happening in the VA's COVER system. They are tracked by bar
code. How are we losing files like this all the time?
Ms. Finn. What we found was the location in the system
doesn't correspond to where the folder is. So when you go to
where the folder was last recorded, it is not there.
Mr. Runyan. Isn't that the purpose of the bar code?
Ms. Finn. The purpose the bar code, yes, is to provide a
system for tracking it. But it requires compliance that people
use the scanner to COVER it in every place it goes. And if
somebody misses doing that step, and then the folder gets put
into a file room, perhaps it gets misfiled and then you can't
find it.
Mr. Runyan. Something that is a little closer to my heart;
it is something I have talked about and haven't uncovered
tremendously, obviously with the conflicts we have been in in
the last 10 years with respect to TBI. And I know how difficult
sometimes it is to diagnose something like that because there
are so many different avenues of how we are going to diagnose.
I know myself, coming out of professional sports, it has been a
new thing. Things weren't talked about before because it was
unprofessional or unmacho to do. And now we are entering a
different type of environment and it is very difficult. But you
indicated the examiners are not providing adequate medical
exams for that. Is it an educated guess? I mean, how are you
able to have a professional make a medical ruling and send it
over to the VBA to have something like that?
Again, there is not a lot of metrics there and it is a
process that I don't think is very sound right now.
Mr. Arronte. What happens with the compensation and pension
exams is that for each type of examination, there is a template
that the examiners are supposed to follow. And the information
in those templates is what VBA needs to make an adequate
decision. What we have found is that the examiners were not
always following the template. They were not answering all the
questions. When we spoke to a few medical examiners at one
regional office that was colocated with a VA medical center,
and they told us that they felt that, one, the rules were
confusing. And second, this is when TBI first became an issue,
they weren't sure what type of examiner should conduct the
exam.
Should it be a neuro doctor, should it be a mental health
doctor? And we have also found that according to one of VBA's
rules, if the veterans has coexisting mental condition and a
TBI, then the medical examiner has to distinguish which
disability is causing the symptoms. VBA's own policy says that
it is almost difficult to make that call, but we are asking
medical examiners to make that call. What we are finding in
some of these exams, they are not making the call because they
can't. They cannot attribute the symptoms to the specific
disability. They don't know if it is a mental disability or
they don't know if it is a residual of the traumatic brain
injury.
Mr. Runyan. It kind of goes right back to what I was
saying. While I believe it is kind of new, I think it is such a
kind of a new--I wouldn't say it was a new disease as we would
call it, it is just very hard to diagnose, and I think, again,
it kind of refers back to what we are saying throughout the
whole process is sound criteria that we are sticking to and not
taking guesses on it.
Mr. Arronte. Correct. We believe that if a medical examiner
answered every question correctly on the TBI template, it would
probably make it easier for the decision makers in VBA to make
a sound decision. We are just not seeing that.
Mr. Runyan. That is all I have. Do you have anything else,
Mr. McNerney?
Mr. McNerney. Yes, actually, if you will allow me.
Mr. Runyan. Yes, sir.
Mr. McNerney. Ms. Finn, I understand that the VA OIG made
86 recommendations to improve performance. Is that correct?
Ms. Finn. I believe the 86 refers to recommendations over
the course of our 16 regional office inspection reports. In our
roll-up report, we had four recommendations to VBA leadership.
Mr. McNerney. Okay. And are those ranked in any kind of
order, or are they just equally important, in your opinion?
Ms. Finn. I think they were equally important. Three of
them dealt with improving the process for obtaining medical,
good medical exams on traumatic brain injuries, and
coordination between VBA and the Veterans Health Administration
(VHA) on those type of exams. And the fourth issue was
establishing a standard of time for when people at the regional
office should make a determination that a veteran was
incompetent and required a fiduciary.
Mr. McNerney. So would you consider comprehensive 21st
Century type reform instituting IT, paperless, you know, that
kind of thing, would you consider that to be something that
would have significant impact?
Ms. Finn. I think, yes, it could definitely have
significant impact. I think it can also be a very difficult
thing to do. We will be taking a look in 2012 at the VBMS
system. My concern with that is we have a lot of veterans from
the Vietnam era and it may be very difficult to ever really
convert their records to any kind of paperless system in a
fashion that provides any kind of real functionality.
Mr. McNerney. I mean, that wouldn't stop us from starting
with----
Ms. Finn. Absolutely not.
Mr. McNerney. And the last question. With claims brokering,
in your opinion, you know, between ROs, would that improve the
situation or not?
Ms. Finn. We have seen mixed results with brokering. We
believe that claims could sometimes have been addressed as
quickly at the original office because brokering has some
overhead in terms of time to process, package up a claim and
move it from one regional office to another. At times we
actually saw claims being brokered to a development center,
back to a regional office, back to a rating center and then
back. That was a lot of time in the mail.
Mr. McNerney. Okay. All right. Well, thank you. I yield.
Mr. Runyan. Thank you very much. Mr. Stutzman, do you have
any questions?
Mr. Stutzman. Yes. Thank you, Mr. Chairman.
Mr. Runyan. You are recognized for 5 minutes.
Mr. Stutzman. Thank you. Thank you for being here and I
appreciate the work that you do, because it is obviously
important for us and the information that you provide. Just a
first question is has the VA followed up on your
recommendations? And what have been the results? What kind of
correspondence, what kind of reception have you received?
Ms. Finn. In the OIG, we follow-up to obtain information
from management as to what they are doing on a recommendation.
That is done centrally. Then the information is shared with the
people in my office who actually wrote the recommendations. We
make a decision as to whether or not we can close the
recommendation based on the evidence so far. We also do a more
traditional follow-up where we actually go out into regional
offices or the environment and evaluate how well the fixes have
addressed the problem. We can do far fewer of those because we
have a lot of new areas we want to look at also. We have used
the benefits inspection program to do is follow up on our
national audits.
For example, the issue of the COVER system, claim files
being lost, and the 100-percent disabilities, came up in
national audits. Our Benefits Inspectors go out and give us a
feel for what is going on in the field and whether or not the
situation is improving. And in most areas we still see issues
so we will continue to work on those.
Mr. Stutzman. Regarding the misplacement and the loss of
claim folders, how is this happening with VA's COVER system
that tracks claims by bar code?
Mr. Arronte. It basically boils down to compliance. When we
do our inspections, we are still seeing staff that do not use
COVERS to track mail or do not use COVERS to track the location
of the claim folders. Now, what happens--sometimes, we see with
the claims folders is somebody will be in a hurry, they will
have the evidence, they want to make a decision and they will
take it to the person that needs to make the decision and they
don't use the system to track the folder. So it is simply a
compliance issue. We see first line supervisors not holding
employees accountable for using the tools that they have
available.
Mr. Stutzman. So it is something just as simple as putting
it in the envelope?
Mr. Arronte. Or scanning the bar code.
Mr. Stutzman. Okay. Thank you, Mr. Chairman. I will yield
back.
Mr. Runyan. Just to touch on that, I mean, is there
anything that you have witnessed through your investigation
that, whether it is a Regional Office Director trying to
develop plans to help us through this, in the oversight
process, the compliance process; is there anything that you
have seen we could do to help them give us some teeth in this
to make the process actually valid?
Mr. Arronte. I am not sure if we have seen anything that is
concrete. Like I said, it is basic supervisory skills and I am
not sure all the supervisors. As Ms. Finn said, we promote
technicians into supervisor positions that don't have the
skills or the understanding all the time what it takes to
supervise. And I think part of it is experience and definitely
part of it is training. Because when you are in this production
environment and you stop producing to train, you have lost that
production time, and you are not going to get that back. And so
sometimes we have seen some regional offices purposely not
train because they don't want to lose that production time.
So the thing is there is a lot of intertwined issues in the
service center. And I am not sure if that is the best answer,
but that is what we see. It is basically supervisors aren't
holding folks accountable.
Mr. Runyan. Thank you. Mr. McNerney, do you have anything
else?
Mr. McNerney. No.
Mr. Runyan. Mr. Stutzman? No? I want to thank you both for
being here and your testimony and look forward to continue
working with you on these important matters. You are both
excused and we will have the second panel up. Thank you all for
being here.
Mr. Runyan. We will be hearing first from Mr. Gerald Manar,
Deputy Director of National Legislative Service of the Veterans
of Foreign Wars (VFW). And then we will hear from Ian de
Planque, Deputy Director of National Legislative Commission of
the American Legion. Then our third witness on this panel will
be Mr. James Swartz, Jr., Decision Review Officer (DRO) at the
Cleveland VBA Regional Office and President of Local 2823 of
the American Federation of Government Employees (AFGE).
And finally, we will have Mr. Richard Cohen, Executive
Director for the National Organization of Veterans' Advocates
(NOVA). We appreciate all of your attendance here today. And
your complete written statements will be entered into the
hearing record. And Mr. Manar, you are now recognized for 5
minutes for your statement.
STATEMENTS OF GERALD T. MANAR, DEPUTY DIRECTOR, NATIONAL
VETERANS SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED
STATES; IAN DE PLANQUE, DEPUTY DIRECTOR, NATIONAL LEGISLATIVE
COMMISSION, AMERICAN LEGION; RICHARD PAUL COHEN, ESQ.,
EXECUTIVE DIRECTOR, NATIONAL ORGANIZATION OF VETERANS'
ADVOCATES, INC.; AND JAMES R. SWARTZ, JR., DECISION REVIEW
OFFICER, CLEVELAND VETERANS BENEFITS ADMINISTRATION REGIONAL
OFFICE, AND PRESIDENT, AFGE LOCAL 2823, AMERICAN FEDERATION OF
GOVERNMENT EMPLOYEES, AFL-CIO, AND THE AFGE NATIONAL VETERANS
AFFAIRS COUNCIL
STATEMENT OF GERALD T. MANAR
Mr. Manar. Chairman Runyan, Ranking Member McNerney and
Members of the Committee, thank you for this opportunity to
present the views of the 2.1 million veterans and auxiliaries
of the Veterans of Foreign Wars of the United States on quality
problems within VA regional offices.
In October 2008, rating accuracy for all regional offices
was 86 percent. Four of those offices had quality in the '70s.
Fifteen had rating quality of 90 or above.
In February 2011, the national average had fallen to 83
percent with 15 offices showing quality in the '70s.
Only six offices had scores of 90 or higher.
Quality in the Baltimore regional office plummeted from 84
percent in 2008 to 65 percent today. That means that veterans
in Maryland have a one-in-three chance of receiving a rating
which contains a substantive error.
In the face of this data, the VFW believes that the VA will
not achieve the Secretary's goal of 98 percent quality in
claims processing by 2015. Poor quality is a cancer. It creates
distrust and suspicion among veterans towards VA.
Real quality problems and this atmosphere of distrust have
driven appeals to record levels with over 230,000 appeals
pending today, a 25 percent increase over October 2008.
VFW believes that rating quality results from certain
fundamental problems. We are convinced that VBA's unrelentingly
efforts to reduce the backlog, poorly trained and inexperienced
managers, poor management systems and controls, and an
inability to devise and bring online IT solutions, a sea of new
employees and a host of other problems contribute to a
breakdown of focus on VA's primary mission.
In a review of 16 regional offices as we have just heard,
the VA OIG found widespread management failures including
absent or untimely management reviews of operations, improper
mail handing, untimely establishment of computer controls of
claims, failure to maintain or review diaries in order to
adjust awards, and a fascinating comparison of managerial
vacancies in the five best and worst offices they visited.
These failures are real indicators of inefficient or
inattentive management within some regional offices. We urge
this Committee to consider a study of how VBA selects, develops
and trains individuals for leadership positions. Providing
well-trained effective leaders at the local level is one way to
foster a culture of quality.
While there are several things that VA can do to
significantly improve quality and rating decision-making today,
we believe that VA cannot hope to consistently reach the
Secretary's goal until VA has a computer system which uses
rules based decision-making as an aid to rating specialists.
The VA must find a way to reduce the opportunity for error. It
is only then that these specialists can focus on getting right
those decisions which require judgment, expertise and
experience.
From our perspective, VBMS promises to move VA into the
21st Century. The lack of a comprehensive fully integrated
paperless claims system has contributed to inefficiencies in
claims processing and the backlog.
VBA is still 2 years away from rolling out a serviceable
first iteration. It is for this reason that VBMS is not the
answer to the current problems. Until rules-based decision
capability is incorporated into VBMS, it should not have a
significant impact on either quality or workload reduction.
So what can be done to improve quality especially in
troubled offices? First, restore a mandatory second review of
all ratings.
Today most raters have single signature authority. This
means that once they sign the rating they wrote, no one reviews
it. Mistakes are not identified and corrected. Even experienced
raters have strengths and weaknesses. Providing a second review
ensures that errors are identified and corrected, and ensures
that continued learning and development occur among raters.
Veterans receive better decisions and raters become better at
their jobs.
Allow veterans service officers to do their jobs. Our
written testimony describes a number of practices found in some
regional offices which inhibit or restrict veterans service
officers from representing veterans. Service officers provide
the final quality review a rating receives. We can catch
problems and get them corrected. We must be allowed to do our
job of representing veterans. Failure to do so only results in
more mistakes and appeals.
Finally, fixing problems in regional offices. VBA knows how
to fix struggling offices. Our written testimony describes the
actions they took to fix problems at the Washington regional
office in 1999. We suggest that that experience is a roadmap
for making significant improvements in similarly struggling
offices today.
Thank you for the opportunity to testify before you today.
I will be pleased to answer any questions you may have.
Mr. Runyan. Thank you Mr. Manar.
[The prepared statement of Mr. Manar appears on p. 44.]
Mr. Runyan. And Mr. de Planque, you are now recognized for
5 minutes for your testimony.
STATEMENT OF IAN DE PLANQUE
Mr. de Planque. Thank you, Mr. Chairman. Thank you Ranking
Member McNerney and Mr. Stutzman for having the American Legion
here to speak to you today. We sometimes feel like we could
have gone back to last year's testimony or 2 years ago or 10
years ago or 20 years ago and we would be saying the same
thing. It starts to feel like a broken record. In 1977, when a
veteran wasn't getting benefits and the whole country didn't
really look too well at veterans, it was still an inexcusable
tragedy. But for the last 10 years, we have been at war and the
country, regardless of what they felt about the wars, has been
pretty much unanimous in saying we have to treat the veterans
right. And we are still not doing it, and that is incredibly
frustrating. Rather than go through a big litany of all of the
things that continue to go wrong over and over and over again,
hopefully a couple of solutions that the American Legion thinks
are going to make some improvements that VA can begin utilizing
now as they are switching to their new electronic system,
because if they don't change the culture at the time they
switch to the new tools, and we have said this before, the
electronic tools are just going to allow them to make the same
mistakes faster, and that is not going to help anyone. That is
going to keep the poor veterans in the same hamster wheel.
VA needs to go forward and they need to increase the
accuracy of the claims. Everybody agrees with this. I think
everyone has unanimously said that there is a quantity over
quality culture. And until they change that, they are not
really going to get any effective change. To do that, you have
to look at how they count work credit. Right now, there is no
difference in whether you do a claim correctly or incorrectly.
And when your manager is breathing down your neck and saying, I
need to get another claim, I need to get another claim, you
need to do this many claims, if you cut a couple of corners
here, if you don't look at it as closely as you need to, you
are under that pressure to do your job.
Nobody can fault the people for doing that, but that is how
errors get passed on. If you create a work credit system that
also takes away credit for errors, one that is not only going
to be answerable for the work that you do, but also recognizes
the work that is done improperly that assesses a regional
office say, for example, a percentage of claims that were done
wrong, then all of a sudden there is an incentive to be doing
those claims right. And sometimes that means slowing down a
little bit. And slowing down a little bit is a part of that.
I am sure you will hear later the VA employees talk about
the amount of time that is allocated for training and the 85
hours a year that they do for training. And yet if you go into
any of the regional offices, the American Legion makes a number
of regional office action review visits every year where we go
in and spend a week in the regional office talking with the
employees, reviewing claims, looking for common errors.
It is the same thing. You talk to them and they will point
out that training is lip service at best; that there is too
much pressure to actually make the numbers, that they don't
have the time to do the training right. Slow down. Breathe.
Train, and maybe you won't make those same mistakes. If you
take advantage of the computer system you have that can tell
you we are getting errors on these claims out of these offices,
you know, the board is noticing the same common areas. If you
hear the court come before you, Judge Lance, Judge Castle, they
will tell you they are seeing the same errors coming out of
offices.
Now you have a computer system. You can start aggregating
that data and saying we are not training people well enough on
TBIs. They don't know how to do it. It is not their fault, they
just haven't been trained well enough to do that. You can fix
that with training. You can pay attention to the training. And
the overall net gain is going to be moving claims out of the
system and bringing down the backlog. VA needs to work at
efficiency, and that means putting somebody experienced at the
front of the process instead of at the end of the process as a
decision review officer. If you take some of those experienced
people and put them up at the front, doing triage, to use a
sports analogy, as a point guard, who knows how to take that
case and go where the best route is for that.
VA demonstrated this recently with the Agent Orange claims
and the expected volume they were getting. They set up a
separate stream just to deal with the Nehmer cases and the
Agent Orange claims they were expecting on the three new
presumptive disorders, and they got those claims out of the
main system in a way that it wasn't clogging up the other work
that needed to be done.
If you have somebody at the front who can look at it and
say this is a complicated thing, this needs to go to a more
experienced person, this is a simple one, we can track this,
you should have the ability with VBMS to be able to direct
these better. And I think that is going to help VA. And I think
they also need to be more transparent. The American Legion has
asked for a while to, in addition to Monday morning workload
reports, listing the number of claims that they have done, to
list the accuracy rating, to list what the real accuracy is for
that office. That helps show the employees, look, we care about
this too. We don't just care about the number of claims you do
every week, we care about the accuracy too. I think if they are
more transparent, if they are more honest and open with people,
then the veterans community is going to give them the time they
need to get it right.
And the one thing that I do want to sum up, I think the VA
employees want to work hard at this. I was speaking with a VA
claims worker in one of the offices during a review. And this
was an Afghan veteran who was looking at me and he said, you
know each of these claims is another veteran. It is another
person just like a guy in my platoon or a woman in my platoon.
And here's a case file that is this thick. I have 2 hours. How
am I giving that veteran justice? They are under the gun. They
are under the pressure. They want to do a good job. They need
to have it relaxed so that they can do that job. And I hope we
can give that to them. Thank you very much and we are happy to
answer questions.
Mr. Runyan. Thank you, Mr. de Planque.
[The prepared statement of Mr. de Planque appears on p.
48.]
Mr. Runyan. Mr. Cohen, you are now recognized for 5
minutes.
STATEMENT OF RICHARD PAUL COHEN, ESQ.
Mr. Cohen. Good morning Chairman Runyan, Ranking Member
McNerney and Members of the Committee. On behalf of the almost
500 VA accredited attorneys and non attorneys who represent
veterans for a fee, and on behalf of the thousands of veterans
who we have represented, I would like to thank you for the
opportunity to bring to this Committee what we have experienced
working in the trenches. I am not going to go through the
litany of problems that the VA has. They are of record. They
are in the reports. You know about them. A question was raised
about the characteristics of the worst performing regional
offices. Understand that all the regional offices are not
performing their job in an accurate and timely manner, but the
worst performing regional offices tend to be those which look
at veterans and their representatives as adversaries, rather
than as people who are trying to get benefits that the veterans
have earned.
The service officers will tell you the same thing as the
NOVA members. When we come to one of those worst performing
regional offices, it is like pulling teeth to look at the
claims file, to talk to one of the people who is in charge of
doing ratings, or a decision review officer. That is one of the
problems.
Now, this is not solely a problem of employees. I will echo
what has already been said. This is not a problem of employees
at the line level not wanting to help veterans. It is, however,
a problem of middle management, which hampers the line
employees from doing what they want to do. Middle management is
not only hampering the employees from doing what they want to
do, but middle management is undercutting the Secretary. The
Secretary has come out repeatedly with statements that the VA
is going to put veterans first, and is going to advocate for
veterans. And then middle management comes out with regulations
or proposed legislation which will hurt veterans, and NOVA ends
up coming to hearings and saying how this is ridiculous, this
will make the system worse. There is no reason for the VA to
come out with anti-veteran legislation except that middle
management has a vested interest in keeping things the way they
were. This system will not change until the VA cleans house,
gets rid of people who don't buy in to the new mission.
There was a report that came out in 2009, a cycle report
from a company called Booz Allen. That cycle report talked
about the problems created by the work credit system. It talked
about the problems caused by ineffective measurement of
accuracy, in which the VA says that they are measuring accuracy
in the STAR system. However, if you look at what happens when
those denied claims are appealed to the Board of Veterans'
Appeals level, you will see that 70 percent of them, when they
get to the Board, are either remanded or outright reversed.
That means that the accuracy rate is 30 percent or less.
Understand, not every claim that is denied or partially
granted gets appealed. Frequently, more than half the time
veterans get so frustrated they throw their hands up, they go
back to wherever they were, in the woods, in the basement, and
they tell their friends it is useless. They say, I am not
dealing with that government. I am not dealing with that
government to try to get benefits and I am not dealing with
that government either to get treatment. So we have veterans
who are untreated and are prone to the PTSD symptoms, to the
TBI symptoms and to suicide.
NOVA has said over and over again that it is not the fault
of the line workers who are trying to do the best job they can.
It is not the fault of Congress which has been trying to get
something done.
In 2008, Congress directed the VA to change the law as to
substitution to change their training and to change the work
credit system. Nothing happened. NOVA recently, this year,
filed a lawsuit to compel the VA to issue the substitution
regulations. Now they have been issued in a proposed form. This
demonstrates that the VA is not capable of doing what it knows
it needs to do and that Congress' attempts to effectuate a
change have not been effective. That is why we have this
decision from the 9th Circuit which now will compel the VA to
put in the time limits that NOVA has said they should.
And we think that, echoing what was said before, the VA
needs to understand that you don't measure accuracy at the
moment. You measure accuracy when the claim is concluded. You
look and you see if you have it right. I can tell you if their
claim adjudication is accurate, and I can tell you that they do
not have 90 percent accuracy, even though--or 80 percent that
they are claiming. Their accuracy is 20 to 30 percent. Thank
you. I am available to answer any questions you have.
[The prepared statement of Mr. Cohen appears on p. 53.]
Mr. Runyan. Thank you, Mr. Cohen.
Mr. Swartz, you are recognized for 5 minutes.
STATEMENT OF JAMES R. SWARTZ, JR.
Mr. Swartz. Thank you for the opportunity to testify on
behalf of the American Federation of Government Employees and
AFGE National VA Council. As a Decision Review Officer, I have
seen firsthand the growing number of complex cases coming into
the regional offices. And let's face it. Because more veterans
are surviving the battlefield with catastrophic injuries and
with the advancements in medical technology for the treatment
of diseases such as Parkinson's, diabetes, coronary artery
disease, the new rash of Nehmer cases nearly doubled the
workload because we are looking at, as a Decision Review
Officer or Rating Specialist, for some of these veterans, four
decades of medical evidence to find the secondary medical
evidence so that we could give the veteran the benefits they
deserve.
As a VA employee and as a disabled veteran, I share that
deep commitment to make sure that VBA gets it right the first
time. But even at what it considered a high performing office
like Cleveland, the claims process is still broken. I urge you
not to rely too much on labels such as high performing and low
performing, which are based, in part, on manipulations of
production numbers that have been used in the past to hide old
cases, in part on the extreme pressure on employees to work off
the clock and take shortcuts and in part on the experience
level of the managers, many of which we have at my own regional
office with less than 2 years experience.
VBA is not going to break the back of the backlog unless it
makes some fundamental changes. First, the new hires need
experienced, skilled supervisors and mentors. They cannot be
rushed into production, and they must be rotated in every
position in their job category, in particular, the veterans
service representative, or VSR, spot.
VBA has to start holding managers accountable for the
quality of ongoing training for experienced employees. Managers
regularly take credit for 85 hours of yearly training, when, in
fact, the employees are told to learn complex new information
on their own with much less allotted training time. Many
employees will print the information out and take it home so
that they are able to take the time necessary to review the
information.
VBA will not break the back of the backlog if employees
with only 2 years of experience keep getting promoted into
management positions who are supposed to supervise, mentor, and
perform quality assurance. Their skills must be tested, just
like that for the frontline employees.
If VBA would finally implement the supervisor skills
certification test, that would address the huge gaps in
knowledge of so many supervisors. An all-skill certification
test would do a better job of measuring what the employee
really needs to know if VBA would start collaborating the test
design with the AFGE and the members who are actually doing the
job.
Also, it simply does not seem right that so few VBA
managers are actually veterans. Veterans bring a unique
commitment to the job itself.
We won't break the back of the backlog as long as VBA
continues to use a broken work credit system. Right now the
number of credits a VSR or rating veterans service
representative (RVSR) has to earn in a day is very arbitrary
and depends on which regional office you work in. They get too
little credit for tests that are essential to getting the claim
decided right the first time. The VSRs in my office only get
credit for the initial development. Any additional development
that is necessary to be done, such as ordering exams, the VSRs
don't get any credit for.
A broken work credit system leads to bad performance
standards. If a DRO, like myself, is working the claim of a
military retiree with 20 to 30 years of service, I am probably
reviewing maybe 40 to 50 years of medical evidence because of
decades of private physician care as well as service treatment
records, yet I am expected to make a decision and print it out
within 2 hours. You can't give the veteran the opportunity that
they need and provide them benefits when you have 2 hours to
review 30 to 40 years of medical evidence. It can't be done.
There is a simple fix, a fix we see every day in the
private industry: Develop a new work credit system based on a
true time-motion study that would show how long it really takes
to complete each step of the claim process. When employees
start getting credit for all the work they need to do, more
claims will be decided right the first time, and there will be
fewer appeals and remands that add to the backlog.
Jumping into another new initiative like H.R. 1647 will
cause VBA to lose, not gain, ground on its fight to break the
back of the backlog. Rather, let us build on the VBA pilots
that are already in place with good training, good supervision
and good performance standards that no longer reward the
shortcuts.
Thank you. I am also available for questions.
Mr. Runyan. Thank you, Mr. Swartz.
[The prepared statement of Mr. Swartz appears on p. 56.]
Mr. Runyan. We will begin questioning of the witnesses now.
Mr. Swartz, talking about the skill certification test, can
you describe your experience a little more and if you believe--
why is there such a low pass rate?
Mr. Swartz. The low pass right, in my opinion, is based on
the training that the VBA employees, are receiving. A lot of
our training is crisis training. This is the new hot topic;
here is 30 minutes of instruction, get to it, and we expect you
to make your production.
I also believe that the testing, the certification testing,
that is being done isn't being done by people who perform the
job. When you are going to contract out something like that to
be designed, it is very difficult for them to actually realize
without having to have done the job itself what questions to
even ask. A lot of the questions--I, myself, have taken the
RVSR certification test and passed it, but a lot of the
questions that were involved were more concerned with different
laws, different rules, different things that weren't really
applicable to rating the case and being able to go through the
evidence and provide for the veteran the disabilities that they
have and the benefits they deserve.
Mr. Runyan. So we are walking down the issue of
standardized tests at that point?
Mr. Swartz. Standardized tests would probably make it a lot
better than it is now.
Mr. Runyan. Do you see any benefit in something I think we
all did when we were in elementary school? For example, as you
failed a test, this is the answer to the question you missed.
Is there any relevance to that? This is how the process works
out?
Mr. Swartz. I think that would make it a lot better for
someone to understand the areas that they may be weak in. We do
get some feedback, but as far as the actual answer to the
actual question, that we don't get.
Mr. Runyan. You have no idea of what you actually failed on
the test then?
Mr. Swartz. All you know is what area you may have been
weak in, but you don't know what part of the area. Now, the
position of an RVSR or a DRO was so specific and has such a
wide range in so many different areas, just telling somebody,
okay, under ordering an exam, you got three wrong, doesn't
really help that person to be able to learn the position and
learn where their mistakes were.
Mr. Runyan. And there is no process there for them to
require them to have further training on what they have missed?
Mr. Swartz. Yes, sir. The feedback system is inadequate.
Mr. Runyan. I think a lot of what we are dealing with--I
think as we move towards an electronic process, I think data
collection on what is wrong is going to be a lot more
accessible and, therefore, we'll be able to get to the issue
much faster.
Mr. Swartz. Sir, if I could address that, the one thing I
would like to say is if we have the paperless claims, speaking
as somebody who does the job, to me, it doesn't matter if that
claim is written on parchment, written on paper, on the
computer or carved into granite. Somebody still has to read
that evidence. They have to diagnose what the evidence has in
it, and they have to be able to make an accurate decision.
Whatever form it is in, the evidence still has to be reviewed.
Mr. Runyan. I was referring more to the metrics of tracking
and mistakes being made. It is more accessible and at your
fingertips a little more readily, and I think it has the
potential to be able to head some of that off. We had a work
credit system bill in Congress a couple of years ago that died
in the Senate, and this may be a time to really dust that off
and revisit that. I think, as Mr. de Planque said earlier,
maybe it is time to take points away for not accomplishing the
task at hand, because I think all of you kind of touched on the
culture and how it needs to change, and I think that would be
one step. Yes, it is an uncomfortable process for people to
have negativity thrown at them, but it is human nature not to
let that happen to yourself. I talk about competition all the
time, Mr. Swartz.
Mr. Swartz. Sir, the one thing I can say is that that is in
place under Aspen, which is the program that is used to keep
track of the work that we do. If we do make a mistake in our
work, and it is caught in a review, we do get that credit
removed. It is held against us, and we are held accountable for
it. Once the mistake is also found, it is brought to the
attention of the rating specialist or the DRO to make the
correction, once it is found. So in that regard, there is
something in place.
In order to do 100-percent review of any of the claims
files that are being done, you would have to double the staff.
For every person who is doing a claim, someone else has to be
able to review the same evidence to find out where it has gone.
Just realistically it is not going to be able to happen unless
we doubled staff.
Mr. Runyan. I understand that.
Mr. de Planque, to really change the culture, do you have
any ideas how to really effectively, economically, fiscally
change that culture like that? Because obviously, like you
said, it seems that you come here year after year with the same
issues. How do we do it without breaking the bank?
Mr. de Planque. Well, effectively and economically and with
the snap of the fingers, it is going to be very difficult. I
mean, obviously things take time to change. But you have to
commit to that, and you have to have people who are willing to
go in and do that.
Mr. Swartz mentioned getting more veterans in there,
veterans who understand looking at a claims file. I recall
seeing cases when I was at the Board of a stressor being denied
for PTSD by saying, well, we looked up the name of your friend
that you said died, and, yes, we confirmed they died, but they
were in Bravo Company, and you were in Charlie Company, so you
wouldn't have known anyone. Well, anyone who has ever been in
an actual military unit knows that that is absolutely
ridiculous. But people aren't going to see stuff like that.
You can get veterans and bring them in, and there is a
large group of unemployed veterans who I am sure could be
trained. They know how to accomplish tasks. They know how to do
things when there is pressure on their shoulders, to go in and
to make life-and-death decisions and to take care of their
fellow veterans. You look at World War II, and people talk
about how the greatest generation came back and built this
country. Well, maybe we have a generation of veterans who can
come back and fix the government and get this working, get the
system working for them, people who are going to be committed
to understand things like that. That is a possibility.
I don't want to create the impression that we want to use
these errors as a rolled-up newspaper to beat people and say,
you are very bad that you made these mistakes. I am talking
about capturing these errors, not just from STAR review, but
also from places like boards of appeals. When you see something
that was done improperly at a lower level, that can be flagged
and tracked back through the electronic system from the Appeals
Management Center, from the courts, to take these things and
use them as a training opportunity, use them as a way--like you
said, if you tell somebody you have something wrong, but you
don't tell them what they did wrong, that doesn't help that
person. But if there is somebody who has a deficiency in
training perhaps and doesn't know how to properly apply the
ratings schedule for post-traumatic stress disorder, then take
that opportunity to go back, fix it, get it better, because
they want to do it right. I mean, the people who are there. And
I think that is more the kind of system that we are looking at.
Mr. Cohen. Mr. Chairman, I think you hit the nail on the
head when you were talking about metrics, and that is the
difference between modern business and the way the VA operates.
We are talking about tracking a case. There is that capability
in the business world. There should be that capability in the
VA world to see what happens with a claim and then to provide
the feedback that the employees need to figure out, why did the
case get reversed? Why did it get remanded? What did you miss?
That is the best kind of training. That is on-the-job training.
The VA is sort of fixated on the STAR system, which is an
internal review of looking at it and saying, oh, yeah, we got
it right. And then they ignore the fact that if that case gets
appealed, the Board says, no, you didn't. We are either
granting benefits or we are remanding because you didn't
adequately develop it. That information needs to get back to
the people who are working in the trenches so they understand,
rather than this arbitrary STAR system which doesn't accurately
measure what is going on with the claims.
Mr. Runyan. Well, I think it goes back to my statement
about your taking your test in elementary school. What did you
get wrong? This is where you went wrong, and this is the answer
to the question. And that is how you design your training
programs around it. You are not feeding people unnecessary
information. So I thank you.
Mr. McNerney, I recognize you for your questions.
Mr. McNerney. Thank you, Mr. Chairman.
I thank the panel for coming up here today.
Mr. Manar, I was pretty depressed by listening to the stuff
you initially said, your words about how in the last few years,
the accuracy has plummeted, and that coincides with the build-
up of new employees, which is consistent with what Ms. Finn
said about the need for good management, the need for training.
These things fit together. I am not hearing anything that is
wildly outside of expectations. It is certainly not what I want
to hear, but there is a consistent message here.
What I would like to do is ask Mr. Cohen, for example--I
mean, your testimony was probably the most critical, and yet
you said, well, Congress has tried to direct the VA and so on,
and nothing has happened. What would be the best role, in your
opinion, for us to play? Are there statutes that we could pass
that would, in your opinion, force the kind of changes that are
needed? Or are we going to sit here and play whack-a-mole
forever?
Mr. Cohen. There is some opportunity for legislative
change. We have in the past raised the idea that the VA is
ignoring their opportunity, which is in statute which allows
them to take a private exam, which is adequate for rating
purposes and use that to rate the claim as opposed to sending
it out for a compensation and pension exam, which takes further
time. Because the statute is written permissively and not in
the form that requires them to accept the private exam, they
don't do so in most cases and consume more time. So that is
something that deals with the time factor.
Another thing that Congress could do is impose deadlines
upon the VA and say, you must decide a claim within 3 months.
Mr. McNerney. But the deadlines are going to continue to
pressure for time for quantity and not quality.
Mr. Cohen. The other thing is this is the time--we have a
very short window of opportunity before the backlog breaks the
back of the VA and not the other way around. This is the time
for a paradigm shift. This is a time when Congress needs to be
thinking about why a criminal defendant is presumed to be
innocent, but a decorated combat veteran is presumed to be a
liar and putting in a phony claim.
Mr. McNerney. What you are saying is all right, but it is
not specific. I mean, you are not giving us direction.
Mr. Cohen. Well, what I am suggesting is that there could
be more statutory presumptions imposed for combat veterans for
the simplest type of cases. That would free up the more
difficult cases. The TBI cases, cases of Lyme disease, other
types of cases are difficult cases medically and legally. These
cases are going to take more time and are going to be difficult
to resolve accurately. But when you have a PTSD case for
someone who has been deployed to an area of combat, Congress
has been trying for the longest time to get legislation passed
to say that if you are deployed to an area of conflict, and you
say that something happened to you, that is going to be enough.
And if you have a diagnosis of PTSD, end of discussion on
whether you have a service-connected condition. The VA should
just move on to the next step and decide how bad is it.
Mr. McNerney. Basically presumption of--say, Agent Orange,
which is what Mr. Filner was so interested in. Let us presume
that anyone that was in Vietnam that has the symptoms that are
associated with Agent Orange has Agent Orange exposure and, is
therefore, entitled to benefits. Is that kind of what you are
getting at?
Mr. Cohen. Presumptions will save time for the VA and allow
the VA to work. If we have presumptions for the cases that are
most obvious, it will save time for the VA.
I can just tell you anecdotally, it took me 10 years to get
a claim decided for service-connected benefits for residuals of
hairy cell leukemia. This was before the VA decided to make it
a presumptive condition, and the VA kept saying, well, we don't
presume it is service-connected, and we don't care that you are
trying to prove it directly through a doctor's statement that
he believes it is service-connected. They wasted 10 years of
the veteran's time and their time on that case, which they
could have granted presumptively from the get-go.
Mr. McNerney. Thank you.
Mr. Swartz, do you think that moving toward IT processing
would be a big advantage? I mean, it sounds like that is
something that you are advocating.
Mr. Swartz. Part of the problem that we have, especially--I
am going to use the National Call Centers as an example. What
the VA has is a lot of programs that they are using, but they
are unable to talk amongst each other. If there was one
centralized program that was not only used by the hospitals
which plays a very important role in our ability to do our jobs
as a rating specialist DRO, but also for people who are calling
in.
Now, they have the National Call Center, and I can tell you
from personal experience, my wait time went from 6 minutes to
23, and that was a call that I made the other day while I was
preparing to come down here for this trip.
Now, with computer programs that are unable to work
together or talk together, it is very difficult to actually do
the job when, okay, I have to go, and I have to update this
program as it comes up, I have to update this program. Now,
there is one that we use for what is called a statement of the
case. God help you if you open any other program while that one
is up, because you are going to lose all your work. It is very
unfriendly and does not play nice with other programs. And that
is a problem that we have with many of the IT issues that we
have. If you work in the call center, you now have Broome
Closet, Genesys, Variant, RightFax. Then you have the other
programs that we already had in place, none of which talk to
each other.
So when you have an 80-year-old veteran who is unfamiliar
with the process itself, it becomes very frustrating for the
employee to try to provide any kind of real information to that
veteran, because on the average you get 3 minutes to handle the
call because you have to answer so many calls in so much time.
So if you don't have the information before you, you pretty
much give him a scripted answer that is supplied to you, and
you finish the conversation with, ``Is there anything else I
can help you with today?'' Well, yeah, you could answer the
question I just called about.
And those are some of the problems that we are having on
the IT front. One centralized program that everybody could use
instead of several programs that are unable to communicate and
do nothing really but slow you down.
Mr. McNerney. Thank you. I yield back.
Mr. Runyan. Ms. Buerkle.
Ms. Buerkle. Thank you, Mr. Chairman.
And thank you to our panelists for being here today.
I was going to ask all of you--and I will ask this question
following up with Mr. McNerney's question--if you could each
make one specific recommendation to us today about how we can
help our veterans. But before I get to that--and you have 5
minutes, so you can divide it up four ways when you get there.
I do want to just follow up, Mr. Swartz, on IT. You talked
about multiple systems. Is there one system that you could
recommend that we could convert to one system?
Mr. Swartz. Ma'am, that is something I would have to get
back with you on. I, myself, am lucky I can work my home
computer, let alone make any kind of recommendations like that.
That is not my specialty. But if you like, I will get with
AFGE, and we will see if we can provide some feedback for you.
[The AFGE subsequently provided the following information:]
AFGE is not able to recommend a single system that could make
a significant dent in the backlog or assist veterans in other
ways. We do not believe that any IT system can replace the
essential function of a VSR or RVSR thoroughly reviewing the
veteran's entire file. As we have said before, there is no
silver bullet for breaking the back of the backlog.
Currently, claims processing personnel struggle with multiple
IT system that do not'' talk to each other''. VBMS shows some
promise in improving coordination between these multiple
systems. However, it does not appear that the benefits of VBMS
will trickle down to the backlog.
More generally, it is too early in the development process to
know effective VMBS will be in this coordination role. The
system has not been field tested yet. We encourage the
Committee to closely monitor VBMS in the design and
implementation phases.
Finally, with regard to VMBS, an AFGE representative made a
site visit to the VBMS pilot in Salt Lake City on August 26,
2011, and provided the following report:
Currently the VBMS platform is in its first generation.
The platform will incorporate all legacy claims processing
platforms into a single web based system. While the web based
platform has potential to provide a streamlined operating
system for claims processing, effective utilization will be
dependent on employee training.
Based on past technology advancements which have been
released to the field, it would be recommended that VBA begin a
public relations campaign which provides insight and
information of the upcoming release.
Training should be extensive and validated prior to
utilization of the platform on a nationwide scale. To ensure
adequate transition into this new technology, AFGE should be
afforded an opportunity to have subject matter experts in the
Claims Assistant, Veterans Service Representative, Rating
Veterans Service Representative and Decision Review Officer
positions process through the training program prior to
release.
AFGE is supportive of advancing VA's ability to address
the ever growing needs of our claimants, although, AFGE has
trepidation about the potential impact on the human capital as
a result of this platform. The VA cannot exchange human capital
for technology and believe the agency will be able to continue
to meet its mission.
Ms. Buerkle. Good.
And then I will go back to my original question. If each of
the panelists can give us one specific recommendation on how we
could ease the burden of the veterans and be able to process
their claims quicker.
Mr. Manar.
Mr. Manar. I think I just heard you say something that is
part of the problem, and I say that with all due respect. And
the Chairman started off his remarks earlier in the same vein,
and that is talking about timeliness. Let us do things quicker,
quicker, quicker. That is the message that employees are
hearing in the field.
I have been in many meetings with Acting Under Secretary
for Benefits, Mike Walcoff and Deputy Under Secretary Rubens,
and I have seen them out in the field conducting town hall
meetings with employees where they are talking about quality.
This is what they are interested in. But by the time they get
back to Washington and at the end of the day, what the
employees are hearing--not necessarily even from their regional
office directors, but from the first-line supervisors--is that
it is production, production, production. ``You didn't do five
cases a day?'' It doesn't matter that you had a foot and a half
of material to look at today in one case or it was really
difficult stuff. The message that is getting out is production
and timeliness.
Now, there are some fixes for these problems--eventually
some of these computer solutions will help make the easier
decisions. They have already got a couple of calculators for
hearing loss. I mean, you plug in two numbers, numbers for both
ears, and it tells you what the hearing loss should be, the
evaluation for hearing loss. The same thing is true with the
special monthly compensation calculator that has come out
recently. The interesting thing is that the Disabled American
Veterans 30 years ago devised a slide rule with stick figures
on it which does the same thing that this calculator that is
computerized today does.
Be that as it may, they have these solutions, and they are
finding that as they take some of these more mundane mechanical
functions, decisions and computerize them, they are getting
higher quality, higher consistency. They are taking the
opportunity for errors out of the hands of employees and
allowing them more time to work on the more difficult things
that require their experience and judgment.
So I think part of the problem here is that we have to
figure out what the message is. Now, in a wonderful world, we
want to knock down the backlog. But do we want to do it if by
VA standards they are making 20 percent errors or, by some
other assessments, much higher? Are we really serving veterans
if we do that?
Ms. Buerkle. If I could interrupt, I apologize because my
time is rapidly----
Mr. Manar. I am sorry.
Ms. Buerkle. I need one suggestion from you. But I don't
mean to say that we need to rush through this, but I do think
that quality service to the veterans is timely service, and
veterans should have an expectation about when their process is
going to be claimed. I think the two go hand in hand. If a
veteran files his process, and it is undergoing a real quality
review, but it takes 6 months or 9 months or a year, that is a
problem. So I think we have to put the two together. We should
expect timeliness.
Mr. Manar. If I may make one suggestion. Have management
focus on continuous improvement, improving something every day.
If they can do that, even small things, over time, they will
change the processes to allow the employees to make better
decisions more consistently. Thank you.
Mr. de Planque. One thing to tag onto that, because we
understand that process. What is going to help the veterans
during that time--because we don't think about things from the
perspective of who the veteran is who is waiting for that
benefit, and the problem is that they exist in a vacuum of
information. Yesterday was rent day. It was mortgage day. Maybe
you have a spouse and kids who are saying, how are we going to
pay our bills this month, and when is the money coming in from
that, and what is going on? And you call, and you can't get any
information, and you don't really know what is going on.
I think when VA has communicated better--and they have
recently done some pilots where when they sent out the letters,
this is what is going on with your case, and they called and
they talked to the veterans with it--those veterans feel better
about the process, even if it is going to take a little bit
longer. If that is communicated to them, if the veterans
understand up front what the expectation is, if that
expectation is managed, yes, it is going to take a little while
to get this done because we are trying to get it right, and you
have a complicated condition, ma'am, you know, something like
that, I think that is going to help the veterans deal with the
situation, because we don't want to rush people and make too
many mistakes, but at the same time, being out there in that
isolated vacuum of information and not knowing what is going
on, that is the worst part for a veteran.
Mr. Cohen. I will agree that no one suggestion will do
something, but what was just suggested is a very important key.
If the regional offices start calling up veterans and their
representatives and talking to them and saying, let me
understand what kind of a claim are you trying to put in, what
are you looking for; and this is what we have in the claims
file right now, do you have anything else; do you understand
you will need this in order to win your claim; communication
like that takes a little bit of time, but it will allow the
people in the trenches working for the VA to get it right the
first time, and that is what we want. So the communication is
the most important thing.
Ms. Buerkle. Thank you.
Mr. Swartz.
Mr. Swartz. I am not going to reiterate on the
communication, because as a veteran who has waited several
years for having my claims processed and several years for the
remands that were done--and I am in the system, and I know how
frustrating it is for myself--but some of the things we need to
do is stop developing these programs that monitor the employee
and give them programs that they could use to do the job.
One of the other things is the accurate, meaningful
training that the employees need. I myself, I was very
fortunate when I came aboard VBA. I am also a registered nurse,
and I have also spent 8 years Active Duty military, Army. I
spent a lot of time in the infantry. I came into the program
with two-thirds of what is necessary. I had to learn the
specific legal issues in developing and working on claims, but
I am one of the fortunate few.
What we need to have is, I believe, more veterans who have
a vested interest in the VA being successful, especially in
management, and also a training program that gives them the
tools they need to do the job right the first time. Thank you.
Ms. Buerkle. Thank you.
Thank you, Mr. Chairman. I yield back.
Mr. Runyan. Thank you.
I don't have another question. I want to make one
statement. It may sound kind of a little different, but I think
when we look at the definition of ``production,'' I think we
really have to redefine that, because it is kind of something,
I think, as being new to Congress, I think we have a difficult
time dealing with the definition of ``budget'' around here a
lot of times, and that I think there is an obvious correlation
there. We are losing what that word really means. I think we
have to really return to that for the sake of on the budget and
our country, and on the veterans end it is taking care of our
heroes.
Mr. McNerney, do you have any further questions?
Ms. Buerkle.
Gentlemen, thank you for your testimony. On behalf of the
Subcommittee, I thank you for your testimony, and you are now
excused.
Mr. Runyan. At this time I would like to welcome Ms. Diana
Rubens, Deputy Under Secretary for Field Operations, Veterans
Benefits Administration, United States Department of Veterans
Affairs.
Welcome, Ms. Rubens. Your complete written statement will
be entered into the hearing record, and you are now recognized
for 5 minutes.
STATEMENT OF DIANA M. RUBENS, DEPUTY UNDER SECRETARY FOR FIELD
OPERATIONS, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT
OF VETERANS AFFAIRS; ACCOMPANIED BY ALAN BOZEMAN, DIRECTOR,
VETERANS BENEFITS MANAGEMENT SYSTEM, VETERANS BENEFITS
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Rubens. Mr. Chairman, thank you.
Mr. Chairman, Members of the Subcommittee, I appreciate the
opportunity to discuss the Veterans Benefits Administration's
efforts to improve performance at challenged regional offices.
I am accompanied today by Mr. Alan Bozeman, Director for the
Veterans Benefits Management System.
While today's hearing focuses on challenged regional
offices, I would be remiss in not noting the many thousands of
exceptionally hardworking and dedicated employees within VBA's
ranks that are committed to serving veterans every day. They
work in our most productive offices, our challenged offices,
and everything in between doing their level best to meet the
performance standards, both individual and office, that we set.
They are both valued and appreciated members of the workforce
with great pride and the will to succeed in any mission.
We are pursuing strategic goals established by the
Secretary 2 years ago to transform VBA into a high-performing,
innovative, 21st Century organization that is people-centric,
results-driven, and forward-looking. One of VA's highest goals
is to eliminate the disability backlog by 2015, ensuring that
all veterans receive a quality decision at the 98 percent rate,
and taking no more than 125 days.
The performance of all of our regional offices is evaluated
against national and regional office-specific targets based on
our strategic goals. These targets are set at the beginning of
each fiscal year across the various business lines for various
measures, including quality, timeliness, production and
inventory.
The Office of Field Operations and the area directors
regularly match the facilities' achievements against its
performance targets to include monthly dashboard reviews.
Regional office directors and individual employees alike are
held accountable for performance deficiencies, and if a
regional office is not meeting performance targets, improvement
plans for the office are put in place and closely monitored.
The area director will engage in more frequent
communication with an underperforming office. Written
electronic communications, structured telephone calls, and
increased site visits are all used to ensure progress towards
planned targets.
For a number of years, VBA has been pursuing a strategy
that allocated additional resources to regional offices that
perform at a higher level. Our strategy to recruit and expand
operations in locations where we have demonstrated that we can
be competitive and achieve high performance levels has been
impacted in recent years as a result of dramatic workload
increases and our need to rapidly and significantly increase
staffing levels.
This fiscal year has been particularly challenging because
VBA has been utilizing our resource center brokering capacity
to readjudicate previously denied claims for the newly
established Agent Orange presumptive conditions.
As we look at quality, STAR findings provide statistically
valid accuracy results at both the regional office and national
level. STAR error trends are identified and used as training
topics to improve performance. VBA is committed to using those
error trends and accuracy findings to improve overall quality
and to adjust and develop employee training and curricula.
Additionally, we are reviewing and reengineering our
business processes in collaboration with both internal and
external stakeholders to constantly improve our claims process
using best practices and ideas. We are working to simplify
those processes and reduce the burden of paperwork for our
veterans, and streamline the process for our employees.
The new disability benefits questionnaires are being
specifically designed to capture medical information essential
for timely and accurate evaluation of disability compensation
and pension claims.
Regional office performance is expected to improve
significantly through the integration of the rules-based
processing and other calculator tools designed to increase
decision accuracy, consistency, and employee productivity.
The Veterans Benefits Management System is meant to give
VBA a paperless processing environment. The overarching goal of
this long-term initiative for phase 1 was the development and
testing of software, while ensuring integration with existing
databases and legacy claims-processing systems. Claims
processors at the Providence Regional Office began using this
new software to process a limited number of original claims for
disability compensation to validate those capabilities within
phase 1 of VBMS.
Phase 2 began just last month in the Salt Lake City
regional office, building upon the efforts and information
gathered in Providence. Phase 3 is set to begin in November of
2011 at a site yet undetermined, and scheduled for completion
in May of 2012.
VBA employees in all of our regional offices are dedicated
to delivering accurate and timely benefits decisions. We
recognize that there is a variance in the overall performance
of our regional offices, and we must be both vigilant in
identifying shortcomings and aggressive in correcting them.
VBMS and our other claims transformation initiatives are
critical to our future success in improving the performance of
all of our regional offices. We will continue to vigorously
pursue business process and technology-centered improvements
designed to break the back of the claims backlog and achieve
our goal of processing all claims within 125 days at 98 percent
accuracy by 2015.
Mr. Chairman, Members of the Subcommittee, this concludes
my remarks. Thank you again for the opportunity to testify. I
am happy to respond to any questions.
Mr. Runyan. Thank you, Ms. Rubens.
[The prepared statement of Ms. Rubens appears on p. 59.]
Mr. Runyan. At this time I will start with the first round
of questions.
The Inspector General noted several regional offices that
do not perform to VBA's standards and encountered long periods
of time where a senior management position was unfilled. What
are you doing to ensure that these positions are filled so we
can have the necessary oversight?
Mr. Rubens. Yes, sir. I feel that challenge, quite frankly,
every day. We work very closely with the Department as well as
our own human resources community to ensure that, one, if we
have adequate notice that there will be a departure, we post
positions as early as possible. I will tell you that it is a
process of evaluating many applicants from both within and
outside VA and VBA.
Part of our challenge when we see extended periods of
vacancies are, quite frankly, due to our inability to get good
quality candidates. I have a regional office position that I
should have a certificate for today or tomorrow that we have
now posted three separate times in an effort to find quality
candidates. Our challenge is finding the right folks to do the
job, because I don't think that we want to put somebody in
there that we don't have the confidence in the person to make a
difference for the employees and the veterans that we serve.
Mr. Runyan. I am kind of going down that road regarding the
80 to 85 hours of annual training all employees must receive.
How can you really adjust their training to better correspond
with the need of the basic employee instead of having just a
list of training that they need? I know it is something where
you would have to get into the weeds. I know it will probably--
like I said before, it will probably be much easier with an
electronic system because you can find it much quicker and
tailor your system. But is there something there that you are
looking into so you can tailor your program a little more
instead of just having a broad range? Because obviously, as you
say, even finding someone, you know, a senior member, to step
in there, they don't have the qualifications. And to be able to
take somebody you know is capable of doing it and tailor a
program around it, I think it has some legitimacy to it.
Mr. Rubens. Yes, sir. I would tell you that there are a
variety of things that we are doing as we look at not only
training for brand new employees coming into either VBA for the
first time or perhaps being promoted into a new position,
working with compensation service; we are looking at how we can
better ramp up, if you will, those brand new employees more
quickly.
Every year as we establish the training requirements for
regional offices, there will be a set of requirements that we
anticipate as a portion of that 85 hours. But there is also a
portion of that left to the individual regional office
discretion to ensure that if they have some unique issues that
are not a national concern, that they can tailor those things
at the local level.
If, for instance, an employee, however, is having
difficulty with performance, and they identified trends at the
local level for training needs, they will be addressed then
individually for that employee to ensure that if they have a
unique gap, that we try to work with them to ensure we are
addressing just those things to those individual employees.
Mr. Runyan. Kind of going down that same path with the
skill certification tests, you have taken--and I know we kind
of touched on standardized testing, and some of that stuff is
even necessary. Even if it is not a question, if it does relate
to someone actually doing their job, are you able to pull that
kind of out and tailor your training to what is really being
missed in general? Because obviously, I mean, you look at the
low pass rates, and it is mind-boggling sometimes to look at
when you are in the 50 percentile of people passing a test, to
elevate themselves within an organization.
Mr. Rubens. My observation would be that we have begun
implementing certification many years ago with the VSR position
as our first position. We have since expanded that to rating
VSRs as well as journey-level RVSRs. So we have different
certification test in place now for the decision review
officers and, in fact, a new certification test in place for
our supervisors.
As I go back and look at the outcomes for that VSR test, I
see the increase in the scores over time. I think part of that
is as we work together to understand where our gaps are and
making sure that the training meets the needs of those
employees, we are working to ensure that all of those tests are
valid tests.
If I may, the certification tests are definitely helped by
the force of a contractor coming to bear. They are not building
the questions, if you will, though. We bring together subject
matter experts from those positions to develop a pool of those
questions that are of the utmost importance, for instance, for
a VSR, who has to understand the development of a claim and
gathering the evidence as well as the promulgation. So we are
working to ensure that when the test has been taken, the
feedback is given to the individual employee.
Mr. Swartz was accurate. We are not given the specific
answers to each of the individual questions. As the tests are
constructed around various components of a job, we will give
them feedback on this particular type of skill set you need as
a VSR. You missed those questions. The concern, quite frankly,
is that it has taken us a considerable amount of time to build
that pool of questions, and as we give employees multiple
opportunities to take that certification test, we want to
ensure that through the random chance, they aren't just getting
questions that they have had before that we have, if you will,
spoon-fed them back the answers. So we will make sure that the
topic and scenarios and the area of training they need feedback
on, they have gotten that direction.
Mr. Runyan. Okay. Several weeks ago at the legislative
hearing, you mentioned that VBA was planning on placing quality
review reports about the VA regional offices on the Internet. I
had about five interns try to find it on the Web the other day
and were unable to do it. Is it there?
Mr. Rubens. Sir, my recollection is it has been about a
month since that hearing. We talked about the fact that, in
fact, VBA is about to post externally the performance results
for all of our regional offices. You wondered when that would
be available.
We have been engaged in discussion with the highest levels
within the Department for final reviews. My expectation at the
time was that it would be about 60 days before it would be out,
and, in fact, we have had those final reviews with some
constructive criticism in an effort to ensure that the end
users from the outside who may not be familiar with all of the
measures that we can understand the data that they are looking
at, and we are working to make some final adjustments.
We are working towards the time frame I gave you. If there
are some things we can put out now and upgrade later to help
ease the use, that is kind of the tack we are taking. But I
would expect within the next 3 to 4 weeks, we will have that
out there. I will promise to let you know when we have it
publicly facing and send you a link.
[The VA subsequently provided the following information,
which was included as well in the May 3, 2011, Legislative
Hearing record:]
The ASPIRE Web site went live on June 30, 2011. VBA's press
release to announce this is available at: http://www.va.gov/
opa/pressrel/pressrelease.cfm?id=2125.
Mr. Runyan. Thank you very much.
Mr. McNerney.
Mr. McNerney. Thank you, Mr. Chairman.
And thanks for coming today to testify, Ms. Rubens.
I was going to follow up with that question I asked Ms.
Finn. What is the reason we are missing so many managers? Is it
attrition? They are just moving on and leaving holes that take
forever to fill? Is that basically what it is?
Mr. Rubens. I would tell you, sir, that it is a combination
of things. In some cases it is opportunities for promotion, and
folks move on. I would like to tell you that we have some
crystal ball that would allow us to post those jobs to fill
behind before they are empty, but, of course, we don't have
that crystal ball in front of us. So it won't be until a
position is vacated that we will post for that replacement. And
then in some instances, employees move to other positions,
whether they are promotions or not, or retire.
Organizationally, we have experienced a great deal of
change in the last few years. We have about 50 percent of our
staff which has less than 5 years of experience. We have had
great opportunities to do a tremendous amount of hiring in the
last few years, as you mentioned earlier, and that has created
an ongoing opportunity, whether that is, gosh, we need more
supervisors, or do we have more positions at the manager level.
So it has continued to create an almost domino effect where we
continue to find vacancies. We are working very hard to ensure
we are attracting the right individuals to ensure that when we
put them particularly into those senior manager positions, that
they are going to help us be successful.
Mr. McNerney. You know, you listed in your testimony a lot
of things that are taking place, that are taking place under
your management to improve the backlog situation. But we hear a
preponderance of testimony that says we are going backwards. I
just want to know if you believe, you know, that we are
actually going to get there. Are we actually improving? Is the
Secretary's goal anywhere near realistic? If it is not, is
there a goal that we ought to be aiming that at that is
realistic that we can reach? Where do you stand on this? That
is a tough question. I mean, you are responsible here for that
Department. So you have to defend that, and I understand that.
But I would like to hear what you would say.
Mr. Rubens. Mr. McNerney, I do believe that we have a very
overarching plan that focuses not just on one thing. It
includes looking at quality, and I am very cognizant of the
comments regarding the concerns for quality.
There are a number of things that we are doing to ensure
that we address that. Along with the production, I will say the
culture of an advocacy approach for veterans, I believe that
most regional offices have exactly that. When I go in, I can't
tell you a single office I have ever been to where the
employees don't come to work every day trying to do the right
thing for veterans. And I do believe that they are excited and
interested about the initiatives that we have coming and an
interest in ensuring that we meet the Secretary's goals. I
can't tell you that there is anybody out there that would say,
gosh, it is okay to have 800,000 claims pending, because that
is just not the case.
Mr. McNerney. Well, just a little analogy. It is great that
we have all these employees that want to work. And I know they
do because I have met them, and they all want to do the best
they can. But if you look in a place like Libya, there is a
great revolutionary force, and they all want to go out and
fight, and they just didn't have the organization. And we need
that. We need to make sure that we are going in the direction
that gives us the organization.
And I want you to believe that myself and the Chairman and
everyone here wants to help you. We want to know what we can
do. Is it a statute telling you to go make regulations? What is
it that we can do that we haven't done that is going to make
this better?
Mr. Rubens. I would tell you that we have great control
over many things that need to be accomplished. As we utilize
the opportunity for legislative proposals, working with this
Committee and others, we work to take advantage of those
opportunities to identify areas where we can make a difference.
We also recognize that that process can sometimes take an awful
lot of time. So a lot of the focus that we are working from
today is what can we do, if you will, on our own and in our own
means.
And you are right, the employees are out there. And at some
point it becomes, do we have the right leadership in place?
Once we select those leaders, are we providing them with the
appropriate training, whether it is those first-line
supervisors? We have had a lot of new first-line supervisors, I
would say new to VBA and new to supervision, where we have been
working to ensure that they have some immediate tools; that
they are ready to help them understand how best to not only
move from a technical position, but to leading and supervising
people. It is a very different job. We have programs for our
division-level managers, our Assistant Director of Development
program, and our Senior Executive Service (SES) candidate
program, where we are investing in leaders to ensure that we
have folks to work with all of those employees to get the job
done.
Mr. McNerney. Well, again, I would like you to believe that
we want to help you, and I would like us to believe that from
your testimony that we are moving in the right direction.
With that, I would yield back.
Mr. Runyan. Thank you Mr. McNerney.
Ms. Buerkle.
Ms. Buerkle. Thank you, Mr. Chairman.
Thank you to our panelist for being here today.
I am kind of uncertain as to where to start when I read
over the report here. There are so many issues that just are of
great concern. Twenty-three percent of the approximate 45,000
disability claims were processed incorrectly; 82 percent error
rate with 100-percent disability. The VBA's failure to timely
address these claims could result in about a $1.1 billion
overpayment to veterans.
Now, when you started your testimony, you mentioned that 2
years ago you set goals for the VBA, and when this all came to
light, do you feel like you are reaching any of those goals?
Mr. Rubens. Ms. Buerkle, I would tell you that we know that
at the moment we have an uphill battle in front of us with that
much work. But I will also tell you that, for instance, one of
the things that we know that slowed our progress over the
course of this year was the processing of those Nehmer claims
both at the resource centers, where we are readjudicating
previously denied, but also at the regional offices across the
country where they were engaged in processing Nehmer claims
that were received after the Secretary made his announcement,
but before the regulation became final.
At the regional offices we had about 63,000 of those
claims, which we put an awful lot of effort in to ensure that
we were meeting what would be the requirements of the external
oversight from the plaintiffs in the Nehmer suit. As we have
done that, it has slowed our output down, and we are now in the
regional offices nearly done with those 63,000 claims, and that
is allowing us to begin to ensure that we are focused on
quality, but also beginning to pick up the pace in terms of the
output.
At our resource centers where they are working the
previously denied Nehmer claims, we are making great progress
with the goal of September 30 being largely complete with those
claims except for the most complex claims, such as where the
veteran has passed away, and we have to ensure we have the
right next of kin to make that payment to.
Ms. Buerkle. I am sure you have heard the panel before you,
and one of their suggestions that would make things better is
communication with the veteran, a status of his claim. So even
if it can't be processed as timely as he would like, at least
they are hearing from the VBA, and they are understanding what
is going on, that their claim hasn't been dropped, that someone
didn't remember to set a calendar date so that the claim can
back up.
Can you address that? Is there anything in place right now
where the veteran hears from you regarding the status of their
claim?
Mr. Rubens. Actually there is. Last year we implemented a
process by which when we received a claim and we began the
development of that claim, essentially sending the veteran what
could often be a complex letter saying, hey, we have received
your claim, here are the things we need. Well, we are making
that phone call at about the 10-day mark to say, did you get
the letter, did you understand it; and then at the end of about
60 days after that, calling to follow up on any additional
evidence.
I would add to that that we recognize the helpfulness of
making that contact with veterans, and as we build the new
technology, part of the opportunity we are trying to build into
that is the contact with the veteran about, hey, we have your
claim, this is where we are in the process, to ensure that that
communication is strengthened.
Ms. Buerkle. Is it a standard process from regional office
to regional office that at X number of days we reach out to the
veteran with a phone call, and we tell him what is going on
with his claim?
Mr. Rubens. That was the guidance that was issued from the
Office of Field Operations last August. It was at the 10-day
mark and at the 60-day mark that we are making those phone
calls.
Ms. Buerkle. Okay. Now, just one last point, and that is in
your testimony earlier when you were answering a question, you
said at some point we begin to look at whether or not we have
the correct managers, whether we have the correct staff. At
what point--when does it become apparent to you that things
just aren't working here?
Mr. Rubens. I would tell you that during that monthly
review with the area directors and as well as myself, as we
look at performance at regional offices, if we continue to have
a trend without one of several things, an understanding of
perhaps what is causing it, a sense that they are taking action
to delve deeper locally to ensure that if it is local managers
that aren't appropriately managing their division, we will
begin to provide the feedback to them that they are just not
getting the job done, and that we have to first, like any
employee that we would identify performance issues with, look
at are there extenuating circumstance. Or is there some
training that needs to be provided? Is there some help that we
can provide?
But they also come to the table with what they are going to
do. And as the area directors engage in that more, I will say,
consistent and close-in communication with the regional office
about that performance, we will implement through the
performance evaluation process appropriate steps if, in fact,
we cannot, if you will, help them turn that ship around.
Ms. Buerkle. Thank you, Ms. Rubens.
Mr. Chairman, I yield back.
Mr. Runyan. Thank you, Ms. Buerkle.
Any other questions from any of the other Members?
Mr. McNerney, do you have a closing statement you would
like to present?
Mr. McNerney. I don't really have a closing statement. I am
a little nonplussed here. You know, I would like to say that,
well, we can issue statutes. But the kinds of things I am
hearing here, they are regulatory, they are things that ought
to be coming from your office, not from Congress. So what we
are going to have to do between the Chairman and I and the
Members of the Committee is just make sure that we are moving
along in the right direction one way or another. And I can tell
you that that is my intention at this point.
I yield back.
Mr. Runyan. Thank you.
Ms. Rubens, on behalf of the Subcommittee, I thank you for
your testimony and appreciate your past cooperation with the
Subcommittee. We welcome, as the Ranking Member said, working
closely with you, because it is obvious that the claims
backlog--and there are many other issues besides that
confronting our heroes, both past and present. Thank you for
that. Based on what we have heard today, there is no small
amount of work to be done.
I repeat my desire from the Subcommittee's first hearing of
the year to work with Members on both sides of the aisle to
ensure America's veterans receive their benefits that they have
earned in a timely and accurate manner.
I ask unanimous consent that all Members have 5 legislative
days to revise and extend their remarks and include extraneous
material. Hearing no objection, so ordered.
I thank the Members for their attendance today, and this
hearing is now adjourned.
[Whereupon, at 4 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Jon Runyan, Chairman,
Subcommittee on Disability Assistance and Memorial Affairs
Good afternoon and welcome. This oversight hearing of the
Subcommittee on Disability Assistance and Memorial Affairs will now
come to order.
We are here today to examine how to improve underperforming
regional offices.
One of the challenges facing our Nation's veterans is the current
backlog of claims for disability benefits. As of May 31, 2011, there
are over 809,000 claims for disability benefits pending rating at
Department of Veterans Affairs (VA) Regional Offices.
Of this amount, almost 60 percent have languished past VA's
strategic target of completing claims in 125 days. The President's FY
2012 budget projects that the average days to complete a claim will
rise from 165 days in FY 2010 to 230 days in FY 2012.
This data shows that while VA is producing more claims decisions
than ever before, they are clearly not able to keep up with the demand.
Congress is unable to truly understand the make-up of these 809,000
claims and reasons why so many of them take so long to be adjudicated
correctly.
Therefore, I will soon be requesting that the VA Inspector General
direct the Benefit Inspection Division to compile copies of the 100
oldest claims awaiting adjudication at VA Regional Offices and conduct
a review of these claims. I will also ask that this Subcommittee be
provided with a detailed analysis of the type of issues that are
claimed in these files, the average age of the claim, the average age
of the claimant, and other characteristics of these claims such as at
which Regional Office they were processed.
I am hopeful that this analysis will allow the Subcommittee to
better understand why these claims have been in the backlog as long as
they have and how the processing of these claims might be improved.
In addition to seeking answers by identifying trends in the types
of cases that have lingered on long past any reasonable period for
adjudication, this Subcommittee is looking at VA employee performance
and the lack of consistency and quality in rating decisions between
Regional Offices that has been noted in prior IG reports.
We plan to attack this from several different perspectives. Today
we will focus on the underperforming Regional Offices. In a future
hearing I anticipate examining the training of VA employees in claims
processing.
As a former professional athlete, I have an understanding of and
respect for healthy competition. It is one of many tools for measuring
and encouraging peak performance by all. There are regional Offices
that constantly rank in the top tier of performance metrics and
customer satisfaction. We commend and salute those offices for
consistently giving their very best on behalf of the veterans they are
serving. Our veterans, who have given so much, deserve no less.
Competitive comparison can also quickly identify chronically poor
performers. There may be many explanations for this underperformance,
from a lack of training to inadequate resources or even poor
management.
But regardless of the explanation, the failures of these offices
are unacceptable. While there are a few bad employees that contribute
to these mistakes, I do believe that many more are good employees
trapped in a system that makes things difficult.
When our Regional offices fail, those who suffer are the Veterans
served by that office. Heroes in need should not be denied or delayed
help, often for many years, because of the happenstance of where their
claim was filed. This is unacceptable and must end.
Last month, I introduced a bill intended to address this problem
and received some very good input at the legislative hearing from the
VA and several of the VSO's on ways to improve upon the initial ideas
in that bill. I welcome today's witnesses to continue that discussion
and offer their own specific recommendations on how to fix the problem
of consistently underperforming Region Offices.
I would now call on the Ranking Member for his opening Statement.
Prepared Statement of Hon. Jerry McNerney, Ranking Democratic Member,
Subcommittee on Disability Assistance and Memorial Affairs
Thank you, Mr. Chairman.
The stated purpose of the hearing is to examine the VA's poorly
performing regional offices.
Today's hearing also continues this Subcommittee's efforts from the
110th and 111th Congresses to analyze various elements of the
compensation and pension claims process--to improve performance of the
system as a whole and to ensure accurate and accountable claims
outcomes for our veterans. It is our collective quest to vanquish VBA's
backlog of claims and appeals, which currently exceeds one million.
Since 2007, the VBA has added over 10,000 claims processing
personnel and Congress has funded these requests. Yet the backlog still
climbs. However, merely adding more people to the same broken system
does not expedite benefits to veterans and their families. We need to
continue to look at the system with fresh eyes to help VA with managing
its claims processing mission.
At the time of its enactment, the Veterans' Benefits Improvement
Act of 2008, P.L. 110-389, was embraced by many stakeholders as a way
forward for VA to revamp and modernize its claims processing system--to
bring relief to those veterans, their families and survivors who were
languishing in an antiquated system in dire need of reform.
I am pleased that P.L. 110-389 also laid the foundation for a
number of initiatives that VA is currently undertaking, particularly
its Veterans Benefits Management System and Veteran Relationship
Management Initiatives, as well as, the Business Transformation Lab in
Providence, Rhode Island; the Claims Processing Pilot in Little Rock,
Arkansas; and the Virtual Regional Office in nearby Baltimore,
Maryland. It also helped with eliminating confusion regarding the PTSD
stressor proof requirements.
However, the need is still there to focus on comprehensive reform
that will result in a system that reflects improved accountability,
accuracy, quality assurance and timeliness of claims processing for our
Veterans, their families and survivors.
As the VA OIG recently concluded in its report after the inspection
review of 16 VA ROs, VBA is processing 23 percent of its claims
erroneously. To change this, the VAOIG recommended that VA needs to
enhance policy guidance, compliance oversight, workload management,
training and supervisory review in order to improve claims processing
operations.
These conclusions echo many of the provisions in P.L. 110-389 and
the continued chorus from Congress and other stakeholders that say time
and again that the backlog is just a symptom of the problem: the
current system is broken and in need of a major overhaul. We need to
focus on getting the claim right the first time.
I look forward to hearing about how VA plans to implement these
recommendations. While I know that VA has developed a number of
forward-thinking pilots and laboratory initiatives, how will they help
put VA on track to processing its compensation and pension claims in a
virtual environment using a twenty-first Century processing platform
and ensuring quality outcomes.
How will it help deliver the promise to improve accuracy,
consistency, quality and accountability of the claims processing
system?
However, I must caution, that with all of the irons that VA has in
the claims processing fire: let us not confuse activity for action or
confuse processes with progress. The Committee will continue to
stringently conduct oversight to ensure that this confusion does not
occur.
I look forward to hearing from our witnesses today. Thank you, Mr.
Chairman, and I yield back my time.
Prepared Statement of Belinda J. Finn, Assistant Inspector General
for Audits and Evaluations, Office of Inspector General,
U.S. Department of Veterans Affairs
EXECUTIVE SUMMARY
The Veterans Benefits Administration (VBA) faces challenges in
improving the accuracy and timeliness of disability claims decisions
and maintaining efficient VARO operations. In general, based on our
inspections of 16 VA Regional Offices (VAROs) from April 2009 through
September 2010, we projected that VBA did not correctly process 23
percent of approximately 45,000 disability compensation claims.
Our claims sampling showed processing of temporary 100-percent
disability evaluations had the highest error rate (82 percent), due to
staff not putting reminders to schedule reexaminations in the
electronic system. In a nationwide audit of 100-percent disability
evaluations, we projected that VBA failure to timely address these
claims processing deficiencies could result in about $1.1 billion in
overpayments to veterans over the next 5 years. Errors in traumatic
brain injury (TBI) claims processing were second highest (19 percent),
primarily due to inadequate TBI medical examination reports on which to
base disability claims decisions, and raters' not returning these
inadequate reports to the hospitals for correction. We saw improved
accuracy in processing post-traumatic stress disorder (PTSD) claims due
to VA's relaxation of its rule regarding stressor verification. This
change reduced PTSD claims processing errors from 13 percent to 5
percent.
We identified a number of problems in disability claims processing
in need of improved management:
Approximately 75 percent of the VAROs inspected did not
process incoming mail according to VBA policy.
VARO employees delayed making final competency
determinations for approximately one-third of incompetent beneficiaries
and did not always timely appoint fiduciaries to manage their funds.
Seven VAROs did not always correct claims processing
errors identified by VBA's Systematic Technical Accuracy Review
program.
VARO management did not always timely complete Systematic
Analyses of Operations which are intended to identify existing or
potential problems and propose corrective actions in VARO operations.
Based on our inspections work for the period of April 2009 through
September 2010, the Jackson, Mississippi, VARO had the highest level of
overall compliance (70 percent) with VBA policy while the Anchorage,
Alaska, and Baltimore, Maryland, VAROs had the lowest (7 percent). We
recommended that VAROs enhance policy guidance, compliance oversight,
workload management, training, and supervisory review to improve claims
processing and VARO operations. VBA agreed with all of our
recommendations for improvement.
We will continue to look for ways to promote improvements in
benefits delivery operations during our future VARO inspections and
nationwide audits. For example, in FY 2012, we will begin an audit of
VA's efforts to develop and implement the next phase of the Veterans
Benefits Management System, which is intended to facilitate paperless
claims processing and integrate mission critical applications.
__________
INTRODUCTION
Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to discuss issues related to the performance of Department
of Veterans Affairs (VA) Regional Offices (VAROs) as identified in
reports by the Office of Inspector General (OIG). The reports include
audits of the programs and operations of the Veterans Benefits
Administration (VBA) as well inspections conducted in individual VAROs.
I am accompanied by Mr. Brent Arronte, Director, Benefits Inspection
Division, in Bay Pines, Florida.
BACKGROUND
Delivering timely and accurate benefits and services to the
millions of veterans who provided military service to our Nation is
central to VA's mission. VBA, specifically the Office of Field
Operations, is responsible for oversight of the nationwide network of
57 regional offices that administer a range of veterans benefits
programs, including compensation, pension, education, home loan
guaranty, vocational rehabilitation and employment, and life insurance.
These programs will pay out over $72 billion in claims to veterans and
their beneficiaries in fiscal year (FY) 2012, and comprise
approximately half of VA's total budget.
For years, however, the disability compensation claims process has
been the subject of concern and attention by VA leadership, Congress,
and veteran service organizations, due in part to long wait times for
benefits and services and the large backlog of claims pending
decisions. VA also faces challenges improving the accuracy of
disability claims decisions.
As part of our oversight responsibility, we conduct inspections of
VAROs on a 3-year cycle to examine the accuracy of claims processing
and the management of Veterans Service Center (VSC) operational
activities. After completion of our inspection, we issue a separate
report to each VARO Director of the results. In their responses to our
reports, VARO Directors have concurred with our recommendations for
improving the operations of their specific VARO. Recently, we issued a
summary report of the results of our inspections conducted at 16 VAROs
from April 2009 through September 2010 (Systemic Issues Reported During
Inspections at VA Regional Offices, May 18, 2011). This summary report
included four recommendations. The Acting Under Secretary for Benefits
concurred with all recommendations.
Since September 2009, we have consistently reported the need for
enhanced policy guidance, oversight, workload management, training, and
supervisory review to improve the timeliness and accuracy of disability
claims processing and VARO operations. Of those 16 VAROs inspected from
April 2009 through September 2010, the Jackson, Mississippi, VARO (70
percent) had the highest level of overall compliance with VBA policy in
the areas that we inspected while the Anchorage, Alaska, and Baltimore,
Maryland, VAROs had the lowest (7 percent).
Our Statement today will focus on the summary report as well as
nationwide audits of related areas such as mail processing and
fiduciary management to promote broad improvements in VBA programs and
operations.
DISABILITY CLAIMS PROCESSING
Our inspections of 16 VAROs from April 2009 through September 2010
disclosed multiple challenges that management teams face in providing
timely and accurate disability benefits and services to veterans. We
focused our efforts on several specific types of disability claims
processing, including temporary 100-percent disability evaluations,
post-traumatic stress disorder (PTSD), and traumatic brain injury
(TBI). In total, we projected that VARO staff did not correctly process
23 percent of approximately 45,000 claims from April 2009 through
September 2010. We found that the Wilmington VARO had the highest
accuracy rate (89 percent) for claims processing, whereas the San Juan
VARO had the lowest (59 percent). However, we did not review temporary
100 percent evaluations processing at these VAROs.\1\ If we had, these
VAROs' accuracy rates could have been much lower, given the high number
of errors we typically have identified in processing this type of
claim.
---------------------------------------------------------------------------
\1\ In September 2009, we included the review of temporary 100
percent claims to our protocols because it is a high risk area.
---------------------------------------------------------------------------
Temporary 100 Percent Evaluations
In January 2011, we projected VBA did not correctly process
temporary 100 percent evaluations for about 27,500 (15 percent) of
181,000 veterans (Audit of 100-Percent Disability Evaluations, January
24, 2011). We reported that since January 1993, VBA has paid veterans a
net $943 million without adequate medical evidence. If VBA does not
take timely corrective action, it could overpay veterans a projected
$1.1 billion over the next 5 years. The Under Secretary for Benefits
agreed with our seven report recommendations for implementing training
and internal control mechanisms to improve claims processing
timeliness. To date, VBA has implemented two recommendations, and plans
to implement the remaining five recommendations by September 30, 2011.
We followed up on these audit results during our VARO inspections.
We found VARO staff incorrectly processed 82 percent of the temporary
100-percent disability evaluations we reviewed, resulting in
approximately $82 million in overpayments to veterans. About 42 percent
of the improper payments were due to human errors. These errors
occurred when VARO staff did not input reminder notifications in VBA's
electronic system to request reexaminations of these veterans as
required by VBA policy.
Traumatic Brain Injury
From April 2007 through FY 2009, based on outpatient screening of
veterans requesting VA health care treatment following military service
in Operation Enduring Freedom and Operation Iraqi Freedom, VA
determined that over 66,000 could possibly have TBI. Of those
identified through the screening, VA ultimately confirmed that 24,559
had sustained TBI; claims processing workloads corroborated that
amount.
Our VARO inspections showed that staff had made errors in 19
percent of the TBI claims we reviewed. Most of the errors related to
either VA medical examiners providing inadequate TBI medical
examination reports on which to base disability claims decisions, or
Rating Veterans Service Representatives (RVSRs) not returning these
inadequate reports to the hospitals for correction as required. RVSRs
often did not return the inadequate reports due to pressure to meet
productivity standards. A common scenario in TBI claims processing
involved veterans who had TBI-residual disabilities as well as co-
existing mental conditions. When medical professionals did not ascribe
the veterans' overlapping symptoms to one condition or the other as
required, VARO staff could not make accurate disability determinations.
RVSRs' difficulty in following complex TBI claims evaluation policies
also contributed to the TBI claims processing errors.
Post-Traumatic Stress Disorder
VARO staff did not correctly process 1,350 (8 percent) of
approximately 16,000 PTSD claims completed from April 2009 through July
2010. Approximately 38 percent of the errors were due to staff
improperly verifying veterans' alleged stressful events, a requirement
for granting service-connection for PTSD. VARO staff lacked sufficient
experience and training to process these claims accurately.
Additionally, some VAROs were not conducting monthly quality assurance
reviews. For these reasons, veterans did not always receive accurate
benefits.
Effective July 13, 2010, VA amended its rule for processing PTSD
disability compensation claims. The new rule allows VARO staff to rely
on a veteran's testimony alone to establish a stressor related to fear
of hostile military or terrorist activity, as long as the claimed
stressor is consistent with the circumstances of service. This change
significantly reduced processing errors associated with PTSD claims.
Prior to the rule change, we identified a 13 percent error rate in PTSD
claims processing. From the date of the rule change until September
2010, however, that rate had dropped to 5 percent.
Opportunities to Improve Disability Claims Processing Timeliness
In September 2009, as a result of a nationwide audit, we identified
opportunities for VAROs to improve timeliness and minimize the number
of claims with processing times exceeding 365 days (Audit of VA
Regional Office Rating Claims Processing Exceeding 365 Days, September
23, 2009). As of August 2008, VBA had 11,099 claims that had been
pending rating decisions more than 365 days. On average, these claims
were pending 448 days. A primary cause for the slow claims processing
times was VARO workload management plans and VSC staff production
credits that were not linked to timeliness goals, such as the national
target to complete claims ratings within 125 days. VSC execution of the
workload management plans was also inadequate. Although VBA has
performance standards to monitor and evaluate VARO staff performance in
elements such as service delivery (accuracy), claims processing,
customer service, and workload management, those standards are tied to
neither timeliness goals for claims processing phases nor the national
target.
In addition, VARO workload management plans did not adequately
address ten inefficient VARO practices, such as improperly identifying
delayed claims, untimely initial requests for evidence, and untimely
follow-up on requests for evidence. These inefficient practices caused
claims processing delays averaging between 47 and 224 days. For
individual claims, the delays were as long as 817 days (27 months). We
projected that the inefficient VARO workload management plans and
practices unnecessarily delayed benefit payments totaling about $14.4
million for 3,501 claimants an average of 8 months. This report
contained four recommendations to establish goals and revise workload
management policy to help improve claims processing timeliness. The
Under Secretary for Benefits agreed with our findings and
recommendations and VBA implemented all recommendations.
DATA INTEGRITY
Our inspection results showed that VARO staff did not timely
control Notices of Disagreements (NODs)--written communication from
claimants contesting claims decisions. A NOD is the first step in the
appeals process. VARO staff did not input NODs in VBA's electronic
system in 7 days for 37 percent of the claims we reviewed, although
they generally met VBA's pending timeliness goal of 145 days for NOD
processing.
Untimely recording of NODs in VBA's electronic system affects data
integrity, misrepresents timeliness in NOD processing, and provides an
inaccurate account of the total appeals inventory. Such data integrity
issues make it difficult for VAROs and senior VBA leadership to
accurately measure and monitor regional office performance. Further,
VBA's National Call Centers rely upon this information to provide
accurate customer service to veterans regarding their appeals. VARO
Directors concurred with our recommendations to train staff to properly
identify NODs and establish plans to ensure these disagreements are
controlled within VBA's 7-day standard.
MAIL PROCESSING AND CLAIMS FOLDER MANAGEMENT
Timely and efficient mail processing is key to completing claims
processing and providing benefits and services to veterans as quickly
as possible. In September 2009, as a result of a nationwide audit, we
reported that VAROs needed to improve the handling, processing, and
protection of claim-related documents, as well as meet mailroom
security and other operational requirements (Audit of VA Regional
Office Claim-Related Mail Processing, September 30, 2009). In FY 2008,
VBA placed 82 percent of claims under control (i.e. entered claim
information into the electronic application to officially establish a
claim) in 7 days or less after receipt; however, it took an average of
32 days to place the remaining 18 percent of claims under control. The
Under Secretary for Benefits concurred with our findings and
recommendations for addressing these issues. VBA implemented all
recommendations by instituting controls and new policies to improve
mail processing and ensure VARO staff do not improperly destroy
applications for benefits and other official documentation.
In September 2009, based on another nationwide audit, we reported
that VBA had inadequate procedures in place for locating veterans'
claims folders (Audit of VBA's Control of Veterans' Claims Folders,
September 28, 2009). VBA managers did not track the number of lost or
rebuilt folders, consistently enforce Control of Veterans Records
System (COVERS) policies, and establish effective search procedures for
missing claims folders. Misplaced claims folders can cause unnecessary
claim processing delays, reduce the time regional office personnel have
to spend processing claims, and place additional burdens on the
veterans awaiting benefits.
As of February 20, 2009, VBA had assigned about 4.2 million claims
folders to regional offices for benefit claims processing and
safeguarding. We projected that claims folders for an estimated 437,000
(10 percent) veterans were misplaced. Approximately 296,000 (7 percent)
veterans had claims folders at locations different from those shown in
COVERS. Of these misplaced claims folders, we projected about 55
percent were in other locations inside the regional office, and the
remaining 45 percent were at the VA Records Management Center with no
certainty as to why.
We concluded that the remaining 141,000 (3 percent) veterans had
claims folders that were lost. Most of the 141,000 lost claims folders
were for veterans with denied claims or for deceased veterans with no
current payments. VBA officials agreed that some of these folders were
lost, but also Stated that many may never have existed. However, we
discovered evidence in COVERS and the Beneficiary Identification and
Records Locator System that the folders did exist and at one time were
located at Federal Records Centers, the Regional Management Center, or
regional offices. Our report included nine recommendations to improve
tracking and accountability for veterans' claims folders. The Under
Secretary for Benefits concurred with our findings and recommendations.
VBA has implemented seven of the recommendations and plans to implement
the remaining two by August 31, 2011.
Our inspections disclosed similar findings with regard to mail
processing and claims folder management. We found that 12 (75 percent)
of the 16 VARO mailrooms did not always control and process mail
according to VBA policy. This occurred because VARO management and
staff were generally unaware of mail processing requirements, including
accurately and timely date stamping mail received at VA facilities.
Further, VARO workload management plans contained unclear mail
processing procedures or first-line supervisors did not always follow
the guidance delineated in these plans. Consequently, beneficiaries may
not have received accurate or timely benefit payments.
Our inspections also showed that Triage Team staff improperly
managed claims-related mail at 10 (63 percent) of the 16 VAROs
inspected. Triage Teams are responsible for reviewing, controlling, and
processing or routing all incoming mail received from the VARO
mailroom. Untimely control and processing of mail can cause delays in
processing disability claims. Triage Team members did not timely record
receipt and process 21 percent of the incoming mail. In addition, staff
did not properly use COVERS to track the location of 24 percent of
claims-related mail. At one VARO, we found 1,462 pieces of mail waiting
to be associated with veterans' claims folders.
INFORMATION SECURITY
Securing veterans' personal information is critical while
processing VA benefits and services. Unauthorized release of veterans'
personal information can result in compromised data and lost veterans'
confidence in VA operations. In September 2009, we reported VARO staff
had inappropriately placed some claims-related documents in shred bins
(Audit of VA Regional Office Claim-Related Mail Processing, September
30, 2009). Our inspections at nine VAROs also showed that VBA's policy
for safeguarding veterans' personal information was not being followed.
Specifically, we identified 78 instances of improper safeguarding of
veterans' sensitive information. While VBA policy requires that
supervisors perform routine inspections of workstations, some VAROs
were not performing these inspections as directed. Although we found no
evidence of improper document destruction, we did find evidence of
improper storage of documents and other materials containing PII. We
discontinued our review of this topic because the majority of the
material found was of relatively low-risk, such as unredacted training
materials, and its improper safeguarding did not seem intentional.
FIDUCIARY AND ELIGIBILITY DETERMINATIONS
VA must consider the competency of beneficiaries in every case
involving a mental health condition that is totally disabling or when
evidence raises a question as to a beneficiary's mental capacity to
manage his or her financial affairs, including VA benefits. When a
veteran is deemed incompetent, VA appoints a fiduciary, which is a
third party that assists in managing funds for an incompetent
beneficiary.
Our inspections found staff at seven VAROs unnecessarily delayed
making final competency decisions in 54 (34 percent) of 159 cases we
reviewed. Delays ranged from approximately 17 to 530 days. VARO
workload management plans did not make competency determinations a
priority or include measures for oversight of this work. As a result,
incompetent beneficiaries received their benefits directly without
fiduciaries in place to manage their financial resources. While the
beneficiaries were entitled to these payments, fiduciary stewardship
may have been needed to ensure effective funds management and the
welfare of the beneficiaries. The risk of incompetent beneficiaries
receiving benefit payments without fiduciaries assigned to manage those
funds increases if staff do not complete competency determinations
promptly.
At the time of these inspections, VBA did not have a clear,
measurable standard to ensure timely completion of these
determinations. Its policy required ``immediate'' action to make a
determination following a beneficiary's due process period. However,
VARO managers had different interpretations of ``immediate.'' One VARO
Director Stated the term ``immediate'' was unrealistic while four
Veterans Service Center Managers defined ``immediate'' as a period from
3 to 30 days. In response to our recommendation, in May 2011 the Acting
Under Secretary for Benefits determined VBA would implement a 21-day
standard to ensure timely completion of competency determinations
(Systemic Issues Reported During Inspections at VA Regional Offices,
May 18, 2011).
In addition to the inaccuracies related to delays in processing
competency determinations, VARO staff did not follow VBA policy when
determining if beneficiaries were competent to handle VA funds. Staff
incorrectly determined beneficiaries were incompetent without adequate
medical evidence demonstrating they could not manage their affairs.
Additionally, VAROs determined beneficiaries were incompetent without
providing the mandatory 65-day due process period for the beneficiaries
to provide evidence to the contrary.
Further, in March 2011, we reported VBA improperly managed
retroactive and one-time payments of $10,000 or greater awarded to
incompetent beneficiaries served by appointed, professional (non-
spousal), legal custodians (Audit of Retroactive and One-Time Payments
to Incompetent Beneficiaries, March 3, 2011). VBA did not effectively
ensure these payments valued at $10,000 or greater were effectively
coordinated among VBA offices, or that Fiduciary Activities completed
required account management and estate protection actions. Fiduciary
Activities failed to conduct at least one required account management
or estate protection action for 72 (40 percent) of the 180 payments
reviewed. VBA used manual notification processes, lacked policies and
procedures to perform required program actions, and did not ensure
sufficient management oversight. Moreover, Fiduciary Activities either
did not provide training specific to the management of retroactive and
one-time payments to incompetent beneficiaries, or the training was
informal and unstructured. This report included five recommendations
for improvements in VBA's Fiduciary Activities. The Acting Under
Secretary for Benefits agreed with our findings and recommendations and
provided responsive implementation plans.
QUALITY ASSURANCE AND OVERSIGHT
In addition to OIG inspections and audits, VBA has its own
processes for assessing the quality of its disability claims
processing. Our assessment of VARO management controls found weaknesses
associated with correcting errors identified by VBA's Systematic
Technical Accuracy Review (STAR) program. Of the 16 VAROs inspected,
seven did not follow VBA policy when correcting errors identified by
VBA's STAR staff. VARO staff did not properly correct 11 percent of the
errors reviewed. However, VSC management erroneously reported to STAR
staff that all corrective actions were completed. In all instances, VSC
management did not provide oversight to ensure correction of the errors
identified.
Further, VARO management did not always conduct complete Systematic
Analyses of Operations (SAOs). SAOs provide an organized means of
reviewing VSC operations to identify existing or potential problems and
propose corrective actions. VBA policy requires VSCs annually perform
SAOs, covering all aspects of claims processing, including quality,
timeliness, and related factors. Our inspections found six (38 percent)
of the 16 regional offices did not follow VBA policy to ensure SAOs
were timely and complete. We determined 53 (30 percent) of 175 SAOs
were untimely and/or incomplete. VARO management did not provide
oversight to ensure SAOs addressed all necessary elements and
operations of the VSC. By not completing SAOs as required by VBA
policy, management may fail to identify existing or potential problems
that could hamper effective delivery of benefits and services to
veterans. We recommended VARO Directors develop plans to improve
oversight and thereby ensure timely correction of errors identified by
STAR staff and the completion of SAOs. The VARO Directors concurred
with the recommendations and corrective actions are ongoing.
We noted a correlation between VAROs producing complete and timely
SAOs and VSC compliance with other VBA policies. We found that five
VAROs, where managers ensured SAOs were timely and complete, were the
most compliant in other operational activities we inspected.
Conversely, of the six VAROs that had untimely and/or incomplete SAOs,
five had the lowest performance in other operational activities, such
as claims processing, mail handling, and data integrity. The manager of
one of these VAROs considered SAOs to be of little or no value toward
improving VARO performance. At five of the six least compliant VAROs,
vacancies in senior management positions contributed to delays in
completing SAOs and implementing corrective actions. These VAROs had
Director or Veteran Service Center Manager positions vacant or filled
with temporary staff for periods of 5 months or greater. For example,
during the 8-month absence of the Anchorage Veterans Service Center
Manager, that office did not have any senior leadership physically in
place to manage and oversee operations.
We did not provide a recommendation on this issue. However, VBA
would benefit from conducting further analysis on improving the timely
selection and replacement of key VARO leadership positions. We will
continue to look at the effect of management vacancies on VARO
operations during future reviews.
CONCLUSION
VBA continues to face challenges in improving the accuracy and
timeliness of disability claims decisions and maintaining efficient
VARO operations. Our inspections and audit work repeatedly have shown
that VAROs do not always comply with VBA's national policy and struggle
with implementing effective workload management plans and clear and
consistent guidance to accomplish their benefits delivery mission. Our
inspections disclosed a wide disparity between the most and least
compliant VAROs in the areas we reviewed. VBA's own oversight and
quality assurance processes have not been fully effective in closing
this gap and ensuring identification and correction of deficiencies in
VARO operations. Prolonged vacancies in the VARO leadership needed to
drive internal review and promote performance improvement only
exacerbate the situation.
Such claims processing and operational problems result in not only
added burdens and delayed or incorrect payments to veterans, they also
mean wasted Government funds through improper payments that VBA will
not likely recover. While VBA has made some incremental progress
through its own initiatives and in response to our prior report
recommendations, more remains to be done. We will continue to look for
ways to promote improvements in benefits delivery operations during our
future VARO inspections and nationwide audits. We will also conduct
work in related areas, such as an audit in FY 2012 of VA's efforts to
develop and implement the next phase of the Veterans Benefits
Management System, which is intended to integrate mission critical
applications and facilitate data sharing across the Department. This
audit will include examination of project management activities,
architectures, and security for the system development effort.
Mr. Chairman, this concludes my Statement. We would be pleased to
answer any questions that you or other Members of the Subcommittee may
have.
Prepared Statement of Gerald T. Manar, Deputy Director, National
Veterans Service, Veterans of Foreign Wars of the United States
Chairman Runyan, Ranking Member McNerney and Members of the
Committee, thank you for this opportunity to present the views of the
2.1 million veterans and auxiliaries of Veterans of Foreign Wars of the
United States on quality problems within VA regional offices.
Secretary Shinseki has committed VA to achieving a 98 percent
quality level for disability claims by 2015. While we have grown to
appreciate the Secretary's unrelenting focus on improving the
Department of Veterans Affairs, especially those elements affecting
claims processing, and we accept that VA is undergoing significant and
lasting change, I believe we can State without fear of being proven
wrong that the VA will not achieve this goal within the next 4 years.
One need only examine the data to see why we arrived at this
conclusion.
In October 2008, VA's Statistical Technical Accuracy Review (STAR)
report for Benefit Entitlement Accuracy showed that the national
accuracy rate was 86 percent. This reflects 12 month cumulative data
for 56 regional offices. Four (4) of those offices had quality in the
70's; 15 offices had rating quality of 90 or above.
In February 2011 (the most recent data available to us) the
national average had fallen to 83 percent and 13 offices had quality
results of 79 or below. Only 6 offices had rating quality of 90 or
above.
Quality levels in the Baltimore regional office plummeted from 84
percent in 2008 to 65 percent today. That means that one veteran in
three is given a decision which contains at least one material error
affecting service-connection, evaluation or effective date.
Poor quality is a cancer. It is incredibly frustrating to VA
employees, nearly all of whom want to do quality work for veterans,
their families and survivors. Poor quality has also resulted in an
immense well of distrust and suspicion by veterans towards the VA.
Real quality problems and this atmosphere of distrust have driven
appeals to record levels. While national rating quality has dropped
from 86 percent in October 2008 to 83 percent in February, 2011,
appeals backlogs increased from 183,496 to 230,219 (25 percent).\1\
---------------------------------------------------------------------------
\1\ From February 28, 2011, to May 23, 2011, the backlog increased
an additional 5,301 appeals. Monday Morning Workload Report, May 23,
2011. http://www.vba.va.gov/reports/mmwr/.
---------------------------------------------------------------------------
Real problems, practical solutions
There are many reasons to explain VBA's inability to process claims
accurately and consistently from office to office. More than poorly
trained personnel, the main cause of these problems rests with a
culture that has lost its focus. It is our belief, our conviction that
most people within VBA want to do a good job. However, conditions
beyond their individual control keep them from achieving consistently
good work.
We are convinced that VBA's unrelenting efforts to reduce the
backlog, poorly trained and inexperienced managers, poor management
systems and controls, an inability to devise and bring online effective
IT tools and systems, and a sea of new employees and a host of other
problems, many not of VBA's making, contribute to a breakdown of focus
on VA's primary mission: to help veterans and their families to the
fullest extent the law allows.
Management
The VA OIG recently released a report summarizing its findings from
reviews of 16 regional offices from April 2009 through September
2010.\2\ In addition to quality issues, the OIG found widespread
management failures, including absent or untimely Statistical Analyses
of Operations (SAO's), \3\ improper mail handling, untimely
establishment of computer controls, failure to maintain or monitor
proper diaries to review or adjust certain awards, and a fascinating
comparison of managerial vacancies in the five best and worst offices
they visited.\4\
---------------------------------------------------------------------------
\2\ ``Systemic Issues Reported During Inspections at VA Regional
Offices''. VA Office of Inspector General, 11-00510-167, May 18, 2011.
\3\ ``SAOs provide an organized means of reviewing VSC operations
to identify existing or potential problems and propose corrective
actions. VBA policy requires VSCs perform SAOs annually, covering all
aspects of claims processing, including quality, timeliness, and
related factors.'', pg 14, ibid.
\4\ Ibid, pg 15.
---------------------------------------------------------------------------
We believe issues such as improper mail handling, failure to
maintain proper computer controls and diaries and similar breakdowns to
be first and foremost an indication of ineffective or inattentive
management. In any large organization, and some VBA offices are quite
large enterprises, it is reasonable to assume that systems and
processes will break down from time to time. The break down is not the
problem; the problem rests with failing to have effective monitoring
systems to quickly identify a developing situation and procedures in
place to fix the problem before it creates much damage. The creating
and maintenance of these systems is strictly a management function.
Where they are neglected indicates a problem with management.
SAO's are established to force local management to examine specific
areas of their operation on a regular basis. Once per year a manager or
a trusted subordinate is expected to conduct a review of the targeted
function, identify problems and propose solutions.\5\ Regional office
directors are charged with ensuring that SAO's are completed on time
and any identified problems are corrected. Further, VA Central Office
(VACO) routinely conducts staff visits to examine every aspect of
regional office operations and is tasked with ensuring that local
management is performing required activities such as reviews. That the
OIG was able to find so many deficiencies in so many offices points to
a serious breakdown in managerial oversight.
---------------------------------------------------------------------------
\5\ VA Manual M21-4, 5.03, pg 5-1.
---------------------------------------------------------------------------
At one time some SAO's were required quarterly or semi-annually. We
suggest that returning to more frequent formal reviews of operations
would help ensure that problems are identified early and corrected.
Further, we suggest that these SAO's be included in whatever monthly or
quarterly summary of operations to VACO which may currently be required
of regional office directors.
We also suggest that an independent study be conducted to determine
how managers, from the Assistant Service Center Manager position
through regional office Director are developed and selected for their
positions. Years of experience in various Veterans Service Center
positions should be examined. In addition, this study should examine
the extent and nature of training offered to managers at all levels and
the relative quality of such training. It would be interesting to see
how this training differs with that offered to managers of similar
levels of responsibility and pay in both the military and major
corporations. Any study of managers should include other areas of
interest as thought appropriate. The results of this study may be
useful in identifying ways in which VBA can better identify, select and
develop individuals to become more effective leaders within VA regional
offices.
Rating quality and Single Signature Authority
We believe all VA employees want to make quality decisions. That
they fail to do so is a result of poorly constructed systems, sometimes
inadequate training, inadequate or absent mentoring, and quality
reviews which may be adequate to assess regional office quality but are
inadequate to determine individual quality with any assurance.
VA employees should be able to work within a set of systems which
ensure that the opportunity to make mistakes is minimized. In an
industrial setting, employers devise machines that can only be operated
in such a way that the employee cannot put fingers and other body parts
at risk of injury. If somehow an employee is injured, the whole process
is reexamined to identify what must be changed so that future employees
cannot be hurt.
In our view, the rating decision process should be structured in
such a way that errors are impossible in those areas where judgment is
not a factor. That is why we are pleased to see the Compensation
Service adopt new calculators which make purely mechanical
computations, such as field of vision, special monthly compensation
(SMC) and hearing loss, for the rater.
We have been told that use of the SMC calculator has greatly
reduced errors in that area. Development of additional tools to aid
rating specialists will go a long way to increase accuracy and
consistency between raters.
In the last year VA has reviewed its training program for rating
specialists and is introducing changes which promise to better prepare
students for their new jobs. However, we remain concerned that new
raters receive only limited training once they return to their home
offices.
Once formal training is complete, on-the-job training helps
solidify learning, ensure proper application of the material to real
world claims and fosters continued long term growth and development. We
have heard far too many instances of new raters rushed into production
with little mentoring or experience.
Even worse, many new raters have been given single signature
authority well short of their first anniversary on the job. Single
signature authority means that a rater is allowed to write a rating
without further review by a seasoned specialist. Mistakes go
uncorrected; differences in judgment, which might benefit a veteran,
are never explored.
At one time ratings required the review and approval of three
rating board members. One of the three was a medical doctor. As a
result of court decisions, physicians were removed from the rating
boards. Still, two trained raters were required to review and approve
each rating.
Single signature authority was first allowed nearly 20 years ago.
Originally restricted to the most experienced senior raters, its use
slowly expanded to less exceptional raters. In recent years, single
signature authority has been given to more and more new or nearly new
raters as the pressure to resolve an ever growing workload mounted.
If VBA did nothing else to improve rating quality, elimination of
single signature authority and the reinstitution of a mandatory second
review would show immediate and significant improvement in quality.
Just last week a VBA director disclosed that a recently trained group
of raters in his office produced over 660 rating decisions with 85
percent quality, an error rate better than the national rate of 83
percent.
It is no mystery how this group of new raters was able to achieve
what the rest of the Nation could not. Each new rater had a mentor who
reviewed every rating with them. Not only did the mentor ensure that
the veteran receive a more correct rating, every identified problem was
an opportunity for the rater to learn something new.
This suggestion is not new. Highly placed VBA leaders have been
reminded that second and third reviews were once required before a
rating could be promulgated. However, their response has been that the
second review was always pro forma; that the second reviewer blindly
signed the rating to move the work along. While this was undoubtedly
true in some offices and among some employees, the fact remains that
where this process is rigorously followed, quality improves. If this
process has no value, then perhaps VBA can explain why a large portion
of Nehmer cases, those with potential for a significant retroactive
award, require two signatures.\6\
---------------------------------------------------------------------------
\6\ C&P Fast Letter 10-41, pg 4. September 28, 2010.
---------------------------------------------------------------------------
Veterans Benefit Management System (VBMS)
VA management has extensively briefed veterans service
organizations throughout the early stages of development of the VBMS.
We have asked many questions and provided substantive feedback. It
appears that many of our concerns are being addressed as this project
moves forward. Recently a service officer with extensive field
experience from the Disabled American Veterans spent a month working
with the VBMS team. From all reports, the collaboration was very
successful.
From our perspective, VBMS promises to move VA into the 21 Century.
A system like this is decades late. The lack of a comprehensive, fully
integrated, paperless claims processing system has surely contributed
to inefficiencies in claims processing and the backlog.
We believe that VBMS holds great promise for the future. Once fully
functional, it promises to allow VBA to move claims, or parts of
claims, anywhere in the country with the touch of a button allowing
specialists to work on individual elements separately and
simultaneously. The system should be able to electronically capture VA
and military health care records, import data into rules based decision
trees and, in general, allow VA to revolutionize and improve
development and rating decision-making.
However, none of this will happen tomorrow. VBA is still 2 years
away from rolling out a serviceable first iteration. We have been told
not to expect rules based decision capability for several years after
that. While VA's ability to move work electronically will surely
produce immediate efficiencies, it will be years before the full
capability of VBMS can be realized.
It is for this reason that VBMS is not the answer. It provides some
answers, the promise of improved processes and enhanced capabilities.
However, until rules based decision capability is incorporated into
VBMS, it should not have a significant impact on either quality or
workload reduction.
Service Organizations
Congress has recognized that properly trained veteran service
officers can provide a vital service to veterans and their families in
the preparation and presentation of claims within VA. With a veterans
permission, we can review their records, help them develop their claims
and represent them before VA and the Board of Veterans Appeals.
However, our job is not just that of claims preparer. Our role is
that of advocate. To that end we train our service officers in the same
laws, regulations and policies that VA teaches to their staff. Our goal
is to train our service officers to be as good as or better than the VA
employees they deal with on a daily basis.
There are two recurrent problems which frequently arise within VA
regional offices which inhibit efforts by service organizations to help
VA make the most correct decisions possible in disability ratings.
VA policy provides that accredited service officers
holding a veterans power of attorney must be given 2 business days to
review each completed rating. That means that our service officers
provide the very last quality check that those ratings receive before
those decisions are promulgated. This service is provided to veterans
and the VA for free. Other than office space, this service doesn't cost
the government a dime.
Why is it, then, that we regularly hear from service
officers that they were denied the opportunity to review ratings prior
to promulgation? The Acting Under Secretary for Benefits has Stated,
often and loudly, that VSO's must be given those 2 days to review
ratings. To his credit and that of his senior staff, they have
intervened when we have alerted them to a problem at a particular
office. Somehow, however, that policy, that message, is periodically
ignored in the field.
What happens when a service officer finds a problem with
a rating? In the past, he or she would take it back to the rater,
discuss the issue and, often, get it fixed before the decision is
promulgated. When the rating specialist is right, the service officer
learns something new. When the decision is not changed and the service
officer remains convinced a problem exists, they must decide whether to
file an appeal. Whatever happens, this simple common sense process
allows for informal discussion and correction of problems without
having to resort to a lengthy and resource intensive appeal.
It is unfortunate that management in many offices forbid
service officers from conferring with rating specialists. They are
forced to go to a rating team coach, or, in some offices, the service
center manager, with their concerns. All too often, these managers have
less rating experience than the rating specialist who made the
decision.
While the stated objective is to protect the rater from
irregular interruptions, hence maximizing the opportunity for doing
more work, the reality is that the supervisor acts as a filter, and
often not a very good one. If they agree that the rating needs
correction, they must still go back to the rater and explain the
problem as it was explained to them. This is a totally unnecessary
step. What happens all too frequently is that the supervisor fails to
take any action, forcing the service officer to appeal the decision.
We urge VBA to restore the former practice of allowing
service officers to meet directly with decision makers. This is an
efficient method to resolve problems short of the appeal process.
Both of these examples illustrate a problem with the attitude of
management in some VA regional offices. They have come to believe that
allowing service officers a review of ratings prior to promulgation,
and speaking directly with a rating specialist when a problem is
perceived, gets in the way of their production goals. Even if this were
true, and it is not, it shows that they care more about production than
quality.
They are simply not interested in having ratings reviewed and
problems corrected prior to promulgation if it means that a little less
work is produced.
An Illustrative History
The Committee has asked us to discuss our ideas for improving VA
regional offices with the worst quality. We have already mentioned
several things that can be done to improve the quality of decision-
making. We understand that adoption of some of these suggestions,
especially the reinstatement of a second review of every rating, will
reduce production. It has to reduce production. Every hour mentoring
another person is an hour of lost production.
However, if we are indeed serious about improving quality to ensure
that veterans receive the benefits they have earned by their service,
without either over or under payment, then changes must be made.
What can be done to help improve those VA offices with the worst
quality? The past offers a possible answer.
In 1999 the Washington, DC regional office (WRO) was floundering.
Because of its location near VA Central Office, decades of poaching the
best and brightest employees from the WRO ensured a continuous struggle
by the remaining workforce to make decisions with acceptable quality
and in sufficient numbers. Leadership turned over frequently, with some
Directors and senior managers from outside either moving sideways or
down a once promising career path. It was not the office of choice for
those who sought to show their talents and move up. VA internal reports
of the time described the WRO as in ``disarray''.\7\
---------------------------------------------------------------------------
\7\ ``VA Report Says Regional Office Is in Chaos'', Steve Vogel,
Washington Post, April 10, 1999.
---------------------------------------------------------------------------
Faced with a failing office and negative publicity, VBA decided to
make changes. Senior managers were replaced. The new Service Center
Manager had a proven track record of managing adjudication divisions in
different regional offices. He was given the authority to recruit a
half dozen experienced raters from around the country, using bonuses,
and in some cases promotions, to encourage them to move to Washington.
He established a rating training coordinator position, someone who
could set up a training regimen and also mentor rating personnel. He
also had authority to replace those who left with other experienced
staff.
WRO rating personnel underwent total retraining. Each was assigned
a mentor and 100 percent of the work was reviewed and corrected before
it was approved. Every case provided an opportunity for learning.
Regular classes continued long after the retraining program was
completed. The Compensation and Pension Service provided a staff
physician to conduct specialized training on anatomy, physiology,
different medical conditions and the rating schedule.
In the end, these measures produced results. Independent reviews
showed improving quality. Initially, production fell as time was
devoted to retraining and mentoring; however, as employee skills and
confidence grew, so did production. Under intense scrutiny, some
employees left, but those who remained became better raters.\8\
---------------------------------------------------------------------------
\8\ I would like to say that there was a happy ending to this
story. Unfortunately, I cannot. Several years after this effort began,
VBA decided to create the Appeals Management Center (AMC). What's
worse, they placed it in Washington in the same building as the WRO. In
the end, virtually every employee at the WRO in claims adjudication
moved to the AMC. Washington's claims are now processed in Roanoke, VA.
---------------------------------------------------------------------------
In our view, VBA should undertake similar actions at failing
offices. Finding qualified and experienced managers and rating
specialists who are willing to move to the affected offices will be the
most difficult task. That and accepting that production at those
offices will fall off for months, and may never fully recover to
previous levels, while quality improves. But that is the vital factor:
quality improves.
Once VBA makes a serious commitment to improving poorly performing
regional offices, veterans in those States will grow to understand that
their government is serious when it tells them that ``we are here to
help you.''
Mr. Chairman and Members of the Committee, this concludes the VFW's
testimony. We again thank you for including us in today's most
important discussion and I will be happy to answer any questions you
may have.
Prepared Statement of Ian de Planque, Deputy Director, National
Legislative Commission, The American Legion
Executive Summary
The American Legion shares concerns regarding underperforming
Regional Offices. While this problem is systemic and ongoing, with
little change to address the underlying concerns over many years, it is
not unreasonable to believe change can occur if VA is willing to break
the current culture of placing quantity over quality.
The American Legion recommends the following measures to help each
office achieve the goal of becoming a model Regional Office and
avoiding the pitfalls of underperforming Regional Offices.
1. Accuracy--The VA must change the present culture that places a
premium on quantity of claims processed and merely pays lip service to
quality concerns. The system clogs up with unnecessary errors and this
endless cycle of appeals and remanded claims more than any other factor
contributes to the unconscionable backlog. VA must elevate accuracy
rate to the same relevance as the simple number of claims processed and
must back this up with systemic changes which illustrate this
importance to staff at all levels. To this end, the creation of a new
work credit system that not only credits work done, but penalizes work
done improperly will strike a balance between speed and accuracy that
will best serve veterans. VA must move away from present work credit
systems that fail to distinguish between work done right and work
simply passed on to the next level.
2. Efficiency--Reports from the VA Office of the Inspector General
(VA-OIG) indicate that over 90 percent of the claims pending over 1
year in 2008 had been delayed over half a year because of
inefficiencies in the Regional Offices. The American Legion believes
the simplest measure to increase efficiency of operation and best
utilize the new electronic tools becoming available with the Veterans
Benefits Management System (VBMS) is to add an additional experienced
claims evaluation to the front of the claims process to better triage
claims and where they should be directed through the system. By
utilizing the experienced eyes of this ``point guard'' the claims could
be directed into tracks where they could be handled more efficiently.
Claims for presumptive disorders such as those associated with Agent
Orange could be processed in efficient manners similar to those
developed to deal with the influx of cases seen with the addition of
three new presumptive disorders in 2010 and more complicated claims
could be directed to the experienced personnel more capable of dealing
with those claims without error.
3. Transparency--In order to restore trust, VA must become more
transparent in their operations and communicate better to stakeholders
in the community. Publishing accuracy numbers alongside the usual
Monday Morning Workload reports would be a clear indicator that error
rate is just as important as number of claims processed. Providing more
information on how VA offices are meeting the standards will
demonstrate VA's commitment to achieving their stated goals of
achieving an end state with no claim pending over 125 days and an
accuracy rate of 98 percent.
__________
Mr. Chairman and Members of the Committee:
The American Legion welcomes this opportunity to address the issue
of underperforming Regional Offices (ROs) of the Department of Veterans
Affairs (VA). For well over a decade now, The American Legion has
conducted regular site visits as a part of a dedicated quality review
system of the disability claims system. These visits, now entitled
Regional Office Action Review (ROAR) visits, have enabled Legion
personnel to see firsthand the actual operating environment in which VA
conducts the business of adjudicating claims for disability and other
benefits. Obviously, this firsthand knowledge provides ground truth for
assessing the challenges VA faces and in providing analysis of the
obstacles VA continues to stumble over to fulfill their charge to serve
veterans.
How do we even know what ``Poorly Performing'' means to a Regional
Office without clear parameters? By what standard should we measure the
performance of a Regional Office? The American Legion believes that
accuracy should be paramount, coupled with the timeliness of delivering
earned benefits. A model Regional Office needs to be error free and
smooth of operation to deliver benefits to those veterans who have
earned them on time, fairly and consistently.
Sadly, there is little to be said addressing poorly performing
offices of a truly groundbreaking nature. Perhaps the most tragic
aspect of testimony such as this is the broken-record refrain of VA's
inability to deliver benefits to deserving veterans in a timely and
accurate manner. Congress, The American Legion, and many other voices
have continued to ask VA why they fall short of meeting their mission
to deliver benefits to these veterans and all are treated to the
familiar replies. VA acknowledges errors have been made in the past,
but insists they are working on the problem, and the next great
management tool is going to fix all the errors of the past and present
a rosier future to the veterans of America. The rosy future has
stubbornly refused to arrive.
Congress and Veterans Service Organizations such as The American
Legion are not alone in their harsh criticisms of VA for their failure
to meet the needs of veterans. VA's performance has fallen so far short
that the United States Court of Appeals for the Ninth Circuit issued a
scathing decision in the matter of Veterans for Common Sense v.
Shinseki that charged VA with no less than violating the Constitutional
rights of veterans. The chorus call from concerned stakeholders for VA
to set their house in order is growing by levels of magnitude.
Perhaps the system suffers largely from a lack of accountability
for failure. What consequences are in store for VA officials who fail
to address the chorus of complaints leveled at the organization by
veterans and Congress and the rest of the public? The sad answer is
there is little consequence that must be borne by the VA for failing to
meet the needs of the veterans and the public. Sadly, the consequences
of failure are felt not by VA but by the veterans they were created to
serve.
Recently VA Secretary Eric Shinseki set forth the admirable goal
that by 2015 no VA disability claims would be pending over 125 days,
and VA's accuracy rate for claims would be 98 percent. However, not
only has VA failed to make substantial progress towards those goals in
the past year, VA overall has fallen further behind in both categories.
VA's backlog of cases pending over 125 days rose from just under
180,000 claims to over 290,000 claims. Accuracy was also a casualty.
According to a GAO report from March 2010 VA's own self reported STAR
accuracy figures noted a drop from 86 percent accuracy to below 84
percent accuracy. The news gets worse. According to a VA Office of the
Inspector General report issued May 18, 2011 VA Regional Offices are
expected to inaccurately process 23 percent of all claims, dropping
their accuracy numbers even further to a dismal 77 percent.
VA is moving backwards, not forwards, and what fear is being placed
into the hearts of those responsible? VA distributed bonus payments to
Senior Executive Employees (SES) in the Veterans' Benefits
Administration (VBA) averaging $14,000 last year. The figure of $14,000
is interesting, because if an indigent veteran seeking non-service-
connected pension received $14,000 for an entire year's wages they
would be told they earned too much money to be eligible for pension. VA
SES executives can watch over a VBA that saw the Secretary's key goals
leap backwards for a year, making the claims process worse for
veterans, and at the end of the year take home a bonus payment greater
than what thousands of indigent veterans are forced to survive on for
an entire year.
This is not solely an issue of money. Several years ago a massive
scandal within VA was exposed relating to the shredding of personal
documents and evidence sent to VA by veterans. In Detroit alone, over
14,000 documents were found waiting to be shredded improperly,
jeopardizing legitimate benefits for veterans. The documents to be
destroyed included original birth certificates, death certificates,
marriage certificates and discharge documents. These documents were
going to be destroyed, along with any hopes of receiving the disability
benefits due to those veterans. This was not limited to one or two
offices. This problem was found to be systemic and pervasive throughout
the entire system. The implication was clear. VA employees were
destroying veterans' documents, cutting corners to improve their
numbers, and throwing disabled veterans onto the trash heap.
Yet in the aftermath, there were no public waves of firings. VA
expressed remorse, yet very little was publicly seen in terms of
accountability. Perhaps worse, instead of losing jobs, jobs were
created. Because of the shredding fiasco, each Regional Office now has
a GS-12 level government employee tasked solely to overseeing the
destruction of documents. If this job could truly be seen as something
that was a real protection of veterans' personal data, perhaps there
would be justification. However, even VA's own employees internally
joke about ``The GS-12 who has to initial even a blank post-it note
before you can throw it out.'' When pressed about such statements,
under the assumption they were exaggerations, VA employees shake their
heads and state ``Yes, we really have a GS-12 who has to initial
everything we are going to throw out, and it even includes blank
paper.''
To change VA requires a commitment to fundamental cultural change
within VA. The American Legion does not believe this to be out of the
realm of possibility, to the contrary by a few simple yet far reaching
actions, VA can take advantage of the new technologies available to
them and change the culture to a system more meaningful to veterans and
more likely to be able to address their needs. VA must move forward to
be more accurate, to be more efficient, and to be more transparent.
Only when VA truly commits to these goals and ceases mere lip service
to those aims will any real change occur.
VA ACCURACY:
The Monday Morning Workload reports posted regularly by VA on their
Web site represent an interesting window into what publicly matters to
VA. These reports publish raw number of claims on hand, claims decided,
almost anything but the figures continually asked for by veterans'
advocates, figures on accuracy. While VA continues to maintain that
accuracy is equally important to the number of claims processed, but if
it is then Central Office's resistance to putting these figures forward
is something of a conundrum.
If you listen to the words spoken in front of Congressional
hearings by VA officials, absolutely accuracy is vitally important.
However, if you talk to VA employees in the actual offices in the
field, they will tell you point blank that the number one driving
concern, the familiar refrain they are told day in and day out, is to
move files across their desks, no matter what the cost. Somewhere there
is a disconnect between the competing statements. Somewhere along the
way the stakeholders are being told one thing while the office
environment tells a different story.
VA cannot simply give lip service to accuracy. As stated before,
accuracy numbers are falling, not rising. VA is getting worse. Simply
increasing the number of claims processed merely shifts the problem to
another desk. The backlog exists not only in every Regional Office, but
at the Board of Veterans Appeals and at the Court of Appeals for
Veterans Claims. Both of these bodies also must deal with the crippling
backlogs brought about by sloppy work at the lower level where quality
is sacrificed on the altar of speed.
Accuracy can and must be brought to equal standing with speed in
the claims process. To begin with, VA must change the way they count
work credit, or the message will never filter down to ground level.
Until work done right counts more than work simply done, VA employees
will never see that their leadership frowns upon cutting corners at the
expense of veterans. As the system presently stands, it doesn't matter
whether a claim is properly adjudicated, you get credit when it leaves
your desk. With the additional power to track claims afforded by VBMS,
VA should be able to track the eventual outcome of claims. When claims
are found to be done in a sloppy or slipshod manner, when a Decision
Review Officer or Veterans' Law Judge finds that the lower rater never
bothered to consider medical evidence, or blatantly ignored supporting
evidence in a veteran's file, the credit for completing that claim
should be removed.
Yes, credit is due for completing a veteran's claim, but credit
must be taken away for error. This is not dissimilar to the workings of
a checkbook. When work is done positively, you generate credit in the
black, but when your work is riddled with errors and omissions, you
deserve debits to place you in the red. If Regional Offices know their
numbers will be adjusted in accordance with their error rates, and this
is transparently disclosed to all stakeholders, the pressure shifts
from simply moving files from one desk to the next and instead creates
an environment supportive of accurately moving files on when they've
been properly considered. There will always be a balance, to be sure,
but such a simple change in the way work credit is counted has the
potential to shift that balance towards accurate work and away from the
decades old VA culture of purely numbers driven motivation.
VA EFFICIENCY
In a September 2009 audit of VA by the Office of the Inspector
General (VA-OIG) an important yet disturbing trend was outlined. As of
August 2008, when VBA had 11,099 claims pending over 1 year VA-OIG
determined that inefficient workload management in the Regional Offices
delayed 11,063 of those claims, nearly all of them. VA-OIG went on to
state:
``Inefficient VARO workload management caused avoidable
processing delays averaging 187 days for a projected 10,046
(90.5 percent) of the 11,099 rating claims.''
Possibly the greatest single change VA could enact to improve their
efficiency involves shifting experienced workers to the front end of
the claims process. As the system stands now, there is little rhyme or
reason to VA's workflow, but that could change. On the battlefield,
triage exists to sort rapidly through the ranks of the injured to
determine which would benefit most from immediate work. This same sort
of triage is absent from VA's process, but need not be.
Some claims VA must deal with, such as those for a clear cut
presumptive illness associated with Agent Orange, a simple rating
increase based on severity of an existing injury, or a claim in which
all of the material needed to grant the claim have been submitted up
front by the veteran, can be processed more quickly. With an
experienced hand to spot these claims as they are incoming, these
claims can be shunted to ``fast lanes'' and swiftly handled, allowing
for more time to be spent on the more complex claims. VA needs to
average a certain amount of time per claim to keep up with their
inventory and ensure veterans are not getting left behind. With a
little triage to help align the claims with the best route to servicing
those claims, the average time for all claims can be reduced.
VA's use of the new VBMS system can help here as well. The tracking
potential within this system should give VA a great amount of control
of workflow. When claims are electronic in format, the data can easily
be shifted to the teams or rating specialists best suited to deal with
those claims. In many training programs for service officers, new
employees begin with simpler, one issue and straightforward claims to
ensure they understand the overall process. As they gain experience and
comfort with the VA system then they delve into claims of greater
complexity. We are often reminded by VA of the complexity of
adjudicating claims, and that it can take up to 2 years to become fully
proficient. A good gatekeeper at the beginning of the process can
ensure that the more inexperienced and green claims processors are
receiving simpler claims within their skill level, and not being tossed
into a deep end over their head with claims too complex for the newer
employees to fairly adjudicate.
The addition of an experienced triage point guard to direct
workflow has the potential to transform efficiency in an extremely
positive way for VA. Furthermore, this is not a radical systemic
overhaul requiring massive changes on behalf of VA and taking years and
studies to develop a plan to implement. This can be initiated with
relative swiftness and can start having immediate impact, and The
American Legion urges VA to consider this addition as they are already
in the transformative process of installing VBMS in all offices. As
these new electronic tools are installed in each office, make this
small adjustment to the work environment come with them to truly help
maximize the impact of the new VBMS tools.
VA TRANSPARENCY
While Secretary Shinseki's stated goal to achieve an operational
state for VA in which no claim is pending over 125 days and all claims
have an accuracy rate of 98 percent is admirable, as stakeholders
outside VA's inner workings it is difficult to track whether this
culture is taking hold. Put quite simply, it seems apparent VA is
tracking what is important to VA, and that is solely the number of
claims processed by each station and the number of claims received. For
all of VA's rhetoric about changing the culture and how important they
view accuracy of claims, when VA publishes their Monday Morning
Workload reports it's still just a numbers game for claims moved from
one desk to another. Until this changes the veterans on the outside
have to remain skeptical about any promises of culture change.
The American Legion has called on VA many times to add tracking of
accuracy rates for Regional Offices to the Monday Morning Workload
reports. These reports on VA's public Web site aren't solely accessed
by veterans' group policy experts or concerned veterans on the street,
VA's own employees look at these reports, and in dozens of Regional
Office review visits conducted by The American Legion a familiar
refrain has come from the employees themselves: ``I know what my boss
is looking at, and if error rate was important it would be on those
reports too. It's numbers. It's how many of these claims I can move on
by the end of the week. That's what my boss cares about.''
Employees are motivated to perform work to meet and exceed the
expectations of their boss. Much as we can be unaware of our non-verbal
cues and the messages they send in social situations, we also must be
aware of what cues we are sending institutionally. VA's institutional
cue is quite clear. We care about the number of claims we process.
There are swaths of data veterans would love to know about their VA
to understand what VA is doing for them. How accurate is the Regional
Office handling my claim? How accurate is VA when it comes to rating my
illness? How many veterans work in my Regional Office? How successful
is the Voc-Rehab group in that Office?
VA regularly makes press releases regarding their agenda and how
they're serving veterans, it's time for VA to regularly publish status
updates on how they're doing. If VA states they are committed to
reducing error rates, they ought to start publishing those error rates
in a place and manner easy to find and be understood.
When VA has discovered problems in hospital operations, such as
sterilization issues in Florida, Georgia, St. Louis and other places,
they embarked on an aggressive awareness campaign to let veterans know
what they were doing to ensure these things wouldn't happen again. When
they did happen again they again aggressively reached out to those
veterans and tried to restore their faith. A broken claims system is
just as devastating as a broken hospital system. Both erode public
trust in something essential, in the belief the government is set up to
serve you the veteran in the manner that you the veteran served the
Nation.
Years of obfuscation, lies, manipulation, stall tactics and similar
ill will have taken their toll on the veteran population. There is only
a finite amount of trust in veterans. VA has squandered much of this
trust. In order to win it back, it's time to start being truly
transparent. VA needs to pull back the curtains, admit to what is
broken, admit to where they fail, and show veterans on a day-to--day
basis how they are improving.
CONCLUSION
It's easy to look at the challenges of the veterans' disability
claims process in a vacuum and forget what ultimately the process is
all about. VA is given a pass on this to a certain extent, and
continues to fall short because to the people who work at VA, from the
bottom to the top, there is little in terms of consequences for
failure. The lack of consequence for failure does not extent to the
veteran on the street however, and perhaps therein lies the greatest
tragedy.
We don't often think about what it means to be a veteran waiting
for benefits, or even what it means to be a veteran applying for
benefits. Soldiers, sailors, Marines and airmen are not people who are
conditioned to admit something is wrong and ask for help. It's not in
their nature to begin with. Many of these veterans have families, and
they seek benefits to help take care of those families only when they
can no longer exist without them.
Dropped into a seemingly endless web of delays and denials, these
systemic properties of the system only further exacerbate the existing
personal doubts and poor self image of the veteran. Nobody talks about
what it feels like to have your spouse question every day ``When is the
VA going to give us the benefits?'' Nobody talks about how it feels
around rent time every month when a veteran is paying their bills and
wondering how they are going to keep for on the table for a child when
they can't work because of what their service cost them.
We, as America, are failing these veterans. Veterans band together
in groups to take care of each other, as we learned in our most basic
training, but we also cannot get by entirely on our own. As painful as
it may be to admit, veterans need the aid of the government to get by
at times, to compensate for the toll on our bodies that we willingly
expended to help carry the government through the execution of its
policies in far off lands. When our country asked, we didn't even stop
to say 'Yes sir' we just did what we were asked. Now when we ask, we
must navigate a labyrinth that would have thwarted Theseus himself.
With electronic tools such as VBMS coming online VA has the
potential to break this maze apart and actually deliver on the promise
to veterans, but without systemic cultural change these new tools will
only allow VA to repeat the errors of the past with greater speed. VA
needs to take steps to be a new VA, and not simply the old VA with thin
facade. Accuracy needs to be a top priority, or the current hamster
wheel of wrongfully denied claims clogging the appeals process will
prevail and the backlog will continue to grow. Efficiency needs to be
addressed, and VA needs to shift work in smarter ways to maximize the
advantages of the electronic system. Finally, VA must pull back the
curtains and stop hiding behind their smokescreens of the past. If VA
is truly proud of their record they need to show that record to the
veterans, and if they're not proud then they need to step up, admit
where they are failing, and show the veterans how they are working to
make the system better. If VA cannot do these things, then the question
remains--how much longer can they continue before the trust is
irrevocably broken?
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
under-performing Regional Offices (``ROs'') of the Department of
Veterans Affairs (``VA'').
NOVA is a not-for-profit Sec. 501(c)(6) educational membership
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
VA, the Court of Appeals for Veterans Claims (``CAVC''), and the United
States Court of Appeals for the Federal Circuit (``Federal Circuit'').
NOVA has written amicus briefs on behalf of claimants before the
CAVC, the Federal Circuit and the Supreme Court of the United States of
America. 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 19-year experience representing claimants
before the VBA.
THE ROs HAVE A LONG HISTORY OF REFRACTORY PROBLEMS
NOVA's previous testimony, together with the June 2009 ``Veterans
Benefits Administration Compensation and Pension Claims Development
Cycle Study'' by Booz Allen Hamilton (``the Booz Allen report'') and
many reports from the United States Government Accounting Office and by
Department of Veterans Affairs Office of Inspector General have
detailed the persistent problems of the Veterans Benefits
Administration (``VBA''), including:
an antiquated and insecure paper file;
inadequately trained employees;
ineffective supervision;
inadequate metrics leading to inability to determine
whether work is performed correctly;
a work credit system which induces employees to rate
claims which have not been properly developed;
an institution which is more concerned with finding
fraudulent claims than timely granting meritorious claims; and
an institution which is so out of control that it takes
years to promulgate needed regulations and which is incapable of
effectively communicating policy to its employees.
Indeed, in a recent decision, the United States Court of Appeals
for the 9th Circuit found that the VA's dilatory adjudications of
veterans' claims denied veterans due process and that time limits for
adjudicating claims must be imposed by the courts. Veterans for Common
Sense v. Shinseki, __F.3d__ (9th Cir. 2011) (No. 08-16728).
Because the ROs are laboring under an avalanche of claims and
employees are judged by a work credit system which rewards paper
pushing over efficient, effective and accurate claims adjudication
(see, Booz Allen report, p.16) the number of pending appeals continues
to increase, thus adding to the frustrations of veterans and other
claimants. During the past year, from May 22, 2010 to May 31, 2011, the
VBA's Monday Morning Workload Reports show a 23 percent increase in
pending appeals from 193,134 to 236,141. Equally startling is the fact
that pending claims have increased by 54 percent and those claims
pending over 125 days have increased by 126 percent. http://
www.vba.va.gov/REPORTS/mmwr/historical/2010/index.asp; http://
www.vba.va.gov/REPORTS/mmwr/index.asp.
There is no one legislative, nor one administrative, initiative
which can rearrange and reconstitute the VA into an efficient and
effective claims processing organization, however, NOVA has some
suggestions which might yield positive results.
ALTHOUGH THE PRIOR ATTEMPT BY CONGRESS TO IMPROVE THE
WORK CREDIT SYSTEM AND VA TRAINING AND SUPERVISION HAS NOT YIELDED
RESULTS, IT SHOULD NOT BE ABANDONED
During October 2008, Congress passed P.L. 110-389, which required,
among other things, that the VA implement an employee certification
exam, that the Comptroller General of the United States evaluate the
VA's employee training program and that the VA study the effectiveness
of the current employee work credit system and work management system,
consider methods for improvement, and report back to Congress.
It is apparent that these tasks have not been accomplished in over
2\1/2\ years and they will not be completed without firm direction from
Congress. By way of example, the VA had not issued proposed
substitution regulations, which were also required by P.L. 110-389,
until February 2011. This followed, and was the result of, a lawsuit
which NOVA filed in the United States Court of Appeals for the Federal
Circuit, to compel compliance with the Congressional directive.
Congress was wise to pass this legislation, and enforcement should
be pursued.
THE VA MUST BE REQUIRED TO MEASURE AND TO REPORT OBJECTIVE ACCURACY
Reports from the United States Court of Appeals for Veterans Claims
show that over 70 percent of the appeals which are decided on the
merits result in the determination that the VA's actions were not
substantially justified. This results in punishment to the VA by an
award of Equal Access to Justice Act fees to the veteran. http://
www.uscourts.cavc.gov/annual_report/. Similarly, in the Board of
Veterans Appeals, almost 70 percent of the appeals are allowed or
remanded, and when the veteran is represented by an attorney, the
positive outcome goes up to 75 percent. http://www.bva.va.gov/
Chairman_Annual_Rpts.asp.
In the face of this clear showing of RO and BVA accuracy of only 30
percent, the VA continues to rely upon internal estimates showing
accuracy of 80 percent or more.
Congress should require the VA to include remand and reversal rates
by the CAVC and by the BVA in the Monday Morning Workload reports and
should further require that tracking of claims through the appeal
process be part of the VA's employee training program. This would allow
a true picture of accuracy and provide relevant on-the-job training.
PRE-ADJUDICATION REVIEW AND CONFERENCES CAN IMPROVE THE VA'S ACCURACY
Apparently, as a result of the VA's awareness that improperly
developed claims lead to erroneous decisions and that, in the rating
process, the most time is consumed by claim development, the VA
continues to try different plans to generate ``fully developed claims''
prior to rating. Remarkably, the VA has never advocated for veterans to
have the right to hire a lawyer, for pay, during the time that the
claim is initially filed and developed, to assist in the claim
development. It is equally remarkable, that the VA appears to be
opposed to working cooperatively with the veteran and his or her
representative to obtain the most complete claim development prior to
adjudication.
Therefore, 38 U.S.C. Sec. 5103(a) should be amended to require the
VA to prepare a claim-specific pre-adjudication review of the claim
which should state precisely what additional evidence is necessary to
substantiate the claim. That written information should also be
communicated, if possible, by phone, to the veteran and to the
veteran's representative, during a pre-rating decision conference. The
result of providing for a meaningful Veterans Claims Assistance Act
notice conference, rather than a useless generic notice, and of working
cooperatively with the veteran and with the veteran's representative
will be to eliminate avoidable remands and avoidable reversals
resulting from inadequate or hasty VA claims development. It will also
result in some unjustifiable claims being withdrawn.
ELIMINATION OF THE SUBSTANTIVE APPEAL CAN SAVE TIME AND SIMPLIFY THE
PROCESS
Presently, in order to place an unfavorable rating decision into
appellate status, a veteran must file a Notice of Disagreement
(``NOD''), with the RO, showing an intent to appeal and, after
receiving a Statement of the Case from the RO, which in many cases
merely restates the information contained in Rating Decision, the
veteran must file a second document to perfect the appeal.
It would be quicker, and in most situations would eliminate the
possibility of the veteran becoming enmeshed in a procedural trap, to
eliminate the second step. Thus 38 U.S.C.Sec. Sec. 7105 (a) and 7105A
should be amended to eliminate the need for a veteran to submit a
``substantive appeal'' or a ``formal appeal'' as is presently required
after the NOD is filed. Instead, once a veteran submits an NOD, 60 days
would be provided to allow for the submission of additional evidence,
and, so long as no additional evidence is submitted, the appeal would
be directed to the BVA for de novo review. However, in cases where the
claimant requests a hearing or submits additional evidence, then the
appeal will remain at the RO for a new decision, which addresses the
additional evidence and/or argument, and either confirms the prior
denial or grants in whole or in part the relief requested.
CONSIDERABLE TIME AND MONEY COULD BE SAVED BY THE VA BY ELIMINATING
UNNECESSARY EXAMS
Presently, the VA will delay rating a claim until after reviewing a
VA generated Compensation and Pension (``C&P'') exam even if there is a
suitable private exam report in the file. Even if a veteran submits a
complete and well-reasoned supporting medical opinion from a treating
or examining physician, the VA's general procedure is to request yet
another medical examination, referred to as a C&P examination. The VA
physicians who provide these medical examinations are employed by VBA,
which is separate and distinct from the VA physicians who provide
medical care to veterans and are employed by the Veterans Health
Administration (VHA). Last year, a report by the VA's Inspector General
revealed that, although C&P exam reports are required to be returned to
the RO within 30 days, there are times when it takes over 180 days for
the RO to receive the exam report. ``Audit of VA's Efforts to Provide
Timely Compensation and Pension Medical Examinations'', March 17, 2010,
09-02135-107, p. 5. www.va.gov/oig/52/reports/2010/VAOIG-09-02135-
107.pdf.
NOVA recommends amending 38 U.S.C. Sec. 5125 to eliminate waiting
for those unnecessary medical exams. The title of Section 5125 should
be amended to read ``Acceptance of Reports of VHA and Private Physician
Examinations.'' The body of the statute should be amended to read as
follows: ``For purposes of establishing any claim for benefits under
chapter 11 or 15 of this title [38 USCS Sec. Sec. 1101 et seq. or 1501
et seq.], a report of a medical examination administered by a VHA
treating physician or a private treating or examining physician that is
provided by a claimant in support of a claim for benefits, including a
claim for increased benefits, under that chapter, if requested by the
claimant, shall be accepted without a requirement for confirmation by
an examination by a VBA physician, so long as the report is
sufficiently complete to be adequate for the purpose of adjudicating
such claim.'' By doing this, the VA would be able to diminish delays
and save money by eliminating unnecessary medical exams and the
subsequent C&P exam reports.
MEASURES IN THE NATURE OF A PARADIGM SHIFT ARE REQUIRED TO SOLVE THE
VA's BACKLOG
In addition to the suggestions provided to eliminate unnecessary
delays and to improve the decision-making procedure, nothing short of a
major change will enable the VA to get control over its burgeoning
backlog which is now over one million claims.
The VA must change its culture to operate under the assumption that
veterans, especially combat veterans, file meritorious claims which
should be fully and quickly granted. Such a change in outlook would
naturally lead to a triage system for claims management which would
dramatically cut backlogs of initial claims and appeals.
The creation and utilization of new presumptions of entitlement to
benefits would eliminate the need for unnecessary and time consuming
development of evidence regarding the incidents of military service for
all those who were deployed to a war zone regardless of their military
occupational specialty or place of assignment within the war zone.
Thus, for example, anyone who was deployed to a war zone, whether
during WWII, Korea, Vietnam, the Gulf War or the GWOT who is
subsequently diagnosed with PTSD should have the sole inquiry, during
the rating stage of their claim, concentrate on the severity of their
symptoms. Anyone who is diagnosed with a medical condition while on
active duty and who is presently being treated for that condition
should not need to prove a medical nexus between the conditions. Also,
veterans who are receiving Social Security Disability or Supplemental
Security Income benefits based on conditions which are related to
service should be presumed to be unemployable.
Prepared Statement of James R. Swartz, Jr., Decision Review Officer,
Cleveland Veterans Benefits Administration Regional Office, and
President, AFGE Local 2823, American Federation of Government
Employees, AFL-CIO, and the AFGE National Veterans Affairs Council
Dear Chairman Runyan, Ranking Member McNerney, Members of the
Subcommittee:
Thank you for the opportunity to testify on behalf of the American
Federation of Government Employees and the AFGE National VA Council
(hereinafter ``AFGE''). AFGE is the exclusive representative of
Department of Veterans Affairs (Department) Veterans Benefits
Administration (VBA) employees who process disability claims.
AFGE welcomes all opportunities to provide input into efforts to
break the back of the backlog, and it is our view that these efforts
cannot succeed without front line employee input. Our members work on
every aspect of the claims process, and many AFGE members working at
VBA are, like me, service-connected disabled veterans who have applied
for VA benefits. Quite simply, we know best which elements of the
claims process work, or do not work.
We take great pride in our strong working relationship with
veterans' service organizations (VSO) on VBA issues and other matters,
and our longstanding support for the Independent Budget. In contrast,
VBA continues to exclude AFGE from a meaningful role in key elements of
the claims process including training, skills certification and
performance measures.
While AFGE members have been directly involved in some of the
current VBA pilot projects, we have had minimal or no input into
others. For example, the Subcommittee asked for our views on the
Veterans Benefit Management System (VBMS). Other than a briefing
earlier this year, we have had virtually no role in VBMS. The first
phase of the VBMS pilot was implemented at the Providence RO, but only
a handful of employees are working on it, and the Providence AFGE local
was not given any role. We were pleased to learn that the VBMS
contractor communicates regularly with the employees assigned to the
pilot.
We understand that the next phase of VBMS will take place at the
Salt Lake City RO. We hope AFGE will have a greater role in VBMS at the
Salt Lake City site and during all future phases of the pilot.
As a service-connected disabled veteran, I especially appreciate
this Subcommittee's oversight of the claims process. I also faced long
delays in getting my claim decided. It simply is not right for a
veteran to wait 18 months for a claims decision. Waiting 2 to 3 years
is absolutely unacceptable.
However, as this Subcommittee has been advised on many occasions,
there are no quick fixes to the claims process. We share the view
expressed by veterans' groups at an earlier hearing that VBA should
complete the current pilot projects before starting others, such as the
pilot proposed by H.R. 1647, that might interfere with their progress,
hinder VBA's ability to manage its workload or have other unintended
consequences.
Within the next 2 years, VBA should see a reduction in the backlog.
Many new hires will have acquired sufficient experience to increase
their production levels. The recent surge of complex Nemer cases will
have subsided. A number of the current pilot projects should be ready
for a national rollout (and will no longer need to divert personnel
from other functions.)
We especially caution against new initiatives that would
restructure VBA based on labels like ``underperforming'' or ``low
performing'' ROs. These are questionable labels that should not be the
basis for major policy changes. RO performance data varies from RO for
many reasons, including:
Number of new hires;
Number of veterans filing claims at each RO;
Experience level of managers;
Quality of employee training;
Whether staff is being detailed to another office (e.g.
managers from Cleveland and other ROs have been detailed to other
offices);
Impact of brokering on performance data (e.g. often two
ROs get credit for the rating of one case);
Finally, and quite significant: How well local managers
manipulate performance data.
Rather than resort to new pilot projects or a major restructuring
of VBA, AFGE urges the Subcommittee to build on current momentum by
addressing three essential components of RO performance: training,
quality of supervision and performance measures.
IMPROVED TRAINING WILL REDUCE THE BACKLOG
VBA training continues to be left too much to the discretion of RO
managers preoccupied with ``making the numbers'' at all costs. It is
widely acknowledged that it takes at least 2 to 3 years for new hires
to get close to ``full production'' Yet, new hires returning from
Challenge training are not getting the on-the-job training, supervision
and mentoring they need to reach that level. They are rushed into
production before they receive adequate hands-on training. Also, rather
than rotating new hires to all stations, many are kept at stations
experience the most problems, which prevents them from being able to
handle a full range of claims later on.
Current employees also face widespread deficiencies with training
provided by VBA to meet the mandatory 85 hour yearly requirement.
Simply put, too often, 85 hours are not 85 hours. Our members
frequently report that managers substitute fixed hours of classroom
training on complex concepts with significantly less ``excluded time''
to learn this information online without any instruction.
As a former Rating Specialist (RVSR), I can say with certainty that
if RVSR training was nationally consistent and of good quality,
variations in performance between ROs would greatly diminish.
On numerous occasions, VBA has made a commitment to Congress to
develop a cadre of national trainers teaching the same curriculum based
on similar interpretations of law and regulations. To date, it has not
delivered on that commitment.
I am not aware of any performance measures that reflect the quality
of training provided by managers or the degree of management compliance
with the 85 hour requirement.
QUALITY SUPERVISION WILL IMPROVE ACCURACY AND TIMELINESS
Given the growing complexity of claims coming into VBA and the
immense pressure to rush new hires into production, it is all the more
urgent that they receive supervision and mentoring from experienced
managers with sufficient expertise.
In addition to mentoring and supervision, RO managers are
responsible for conducting quality assurance and managing the workflow
without sacrificing accuracy. Unfortunately, many VBA managers have
been promoted after only a few years of ``floor'' experience regardless
of their own skill levels.
In 2008, a unanimous Congress enacted Public Law 110-389 that
provided for another needed reform: supervisor skills certification.
This exam is still not in place. Like the skills certification exams
that VSRs and RVSRs must pass, a supervisor certification exam can be a
valuable tool for ensuring that managers know their subject matter--
especially because they are not on the floor processing claims
themselves every day.
As a veteran, I also am troubled by how few managers are veterans
themselves, despite clear veterans' preference rules that apply to VBA.
I know firsthand how veterans' status gives VBA employees a vested
interest in making sure that a veteran gets what he or she earned, and
in a timely fashion. In my RO, only about 5 percent of managers are
veterans, in contrast to at least 40 percent frontline employees with
veteran status.
FLAWED PERFORMANCE MEASURES HURT QUALITY AND PRODUCTION
The 2008 also law mandated that VBA develop an evidence-based work
credit system to ensure that performance measures count all work that
goes into getting a claim processed correctly the first time, including
full claims development. Three years later, VBA still imposes
arbitrary, unrealistic performance measures set through local
management discretion that reward quantity at the expense of quality.
It is urgent that VBA finally comply with the 2008 law, and include
front line employees in the development of these critical measures.
OTHER COMMENTS
Is mandatory overtime cost effective? The current national 20 hour
per month mandatory overtime requirement for all employees has been in
place for a month. We fear the added costs of this requirement far
outweigh the benefits. First, many ROs were already selectively using
mandatory overtime (at a lower number of hours) to increase production.
The new overtime requirement is imposing undue pressure on many
employees with family commitments, and is already leading to
resignations, shortcuts and lower workplace morale. The VBA workforce
was already under intense pressure to make production; mandating more
hours of work may lead to marginal returns at a great cost.
Bonuses: We also urge the Subcommittee to address the issue of
excessive bonuses. Managers at my RO and many others continue to
receive large bonuses regardless of performance, at the expense of
taxpayers, veterans and workplace morale.
National Call Centers: AFGE urges the Subcommittee to look closely
at the National Call Centers (NCC) and assess whether these resources
would be better spent back at the ROs or on a centralized, automated
tracking system for claims. The new Genesys system deprives NCC
employees of adequate time to complete other tasks between calls and at
the end of their shifts. They now have on average only five seconds
(instead of fifteen) between calls. At the end of the day, they have
less than 15 minutes to complete other work, down from 30 minutes under
the old system. As a result, employees are pressured to take shortcuts
and work off the clock.
Genesys is also causing real hardships for veterans. They are on
hold much longer. Employees are expected to work from scripts rather
than provide individualized help. Calls longer than 6 minutes are
discouraged and employees are pressured to keep most calls to 3
minutes. It is simply wrong to limit an 80-year old veteran to a 3-
minute call, especially when it takes 2 minutes just to get him through
the ID protocol!
We also recommend a reexamination of the costs and benefits of the
Broome Closet templates used by NCC employees to answer callers'
questions and create correspondence. In addition to a significant error
rate, this program creates additional steps in the process that cause
unnecessary delays.
Consistency Studies: VBA has been conducting interreliability
studies in the field to test the consistency of DRO and RVSR decisions.
AFGE supports efforts to improve national consistency, but we are
concerned that VBA is not producing reliable data or using these
studies to make real improvements.
High Cost of Poor Personnel Practices: The number of labor-
management problems at ROs is skyrocketing. Rather than working with
employees and their representatives, RO managers are threatening many
hardworking employees with terminations and ``performance improvement
plans.'' These wasteful actions hurt the ability of front line
employees to do their jobs and divert dollars from direct services to
veterans. Holding front line employees responsible for management
failures is not going to solve the backlog. Rather, we should all be
working together on a meaningful solution.
Thank you again for the opportunity to share AFGE's views on this
important issue.
Prepared Statement of Diana M. Rubens, 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 with this opportunity to discuss the Veterans Benefits
Administration's (VBA) efforts to improve performance at challenged
regional offices. I am accompanied today by Mr. Alan Bozeman, Director,
Veterans Benefits Management System (VBMS), VBA.
The Subcommittee has indicated special interest in learning about
the operations of underperforming Department of Veterans Affairs (VA)
regional offices and our efforts to improve performance to ensure
higher quality and consistency of disability claims decisions. We will
address these areas and also provide an update on VBA's implementation
of recommendations made by the Office of Inspector General to improve
regional office operations. In addition, we will update the
Subcommittee on our progress in developing VBMS and the timeline for
its implementation.
While today's hearing focuses on challenged regional offices, I
would be remiss in not noting the many thousands of exceptionally hard-
working and dedicated employees within VBA's ranks that are committed
to serving Veterans every day. They work in our most productive
offices, our challenged offices, and everything in between, doing their
level-best to meet the performance standards--both individual and
office--that we set. They are both valued and appreciated members of a
workforce with great pride and the will to succeed in any mission.
Regional Office Performance
Let me begin by stating that we constantly strive to find new ways
to improve the performance of our regional offices. We are pursuing
strategic goals established by the Secretary 2 years ago to transform
VBA into a high-performing and innovative, 21st Century organization
that is people-centric, results-driven, and forward-looking. One of
VA's highest priority goals is to eliminate the disability claims
backlog by 2015 and ensure all Veterans receive a quality decision (98
percent accuracy rate). VA has defined the claims backlog as any claim
pending more than 125 days
VA is attacking the claims backlog through a focused and multi-
pronged approach. At its core, our transformational approach relies on
three pillars: changing our culture to one that is centered on
accountability to, and advocacy for, our Veterans; improving our
business processes through collaboration with stakeholders and industry
experts on best practices and ideas; and deploying powerful 21st
Century IT solutions to simplify and improve claims processing for
timely and accurate decisions. Our strategic initiatives seek to
improve the quality and timeliness of benefits delivery; expand
accessibility to VA benefits and services; increase Veterans'
satisfaction; and improve VA internal management systems to
successfully perform our mission.
The performance of all of our regional offices is evaluated against
national and regional office-specific targets that are based on our
strategic goals. These targets are set at the beginning of fiscal year,
across all the business lines and for a variety of measures, including
quality, timeliness, production, and inventory. In setting targets,
consideration is given to the previous year's performance and current
staffing levels.
VBA's Office of Field Operations and the Area Directors regularly
match a facility's achievements against its performance targets, to
include a monthly dashboard review. Several factors influence
performance including workload, workforce experience, and staff
turnover. VBA closely monitors regional office performance, and should
negative performance trends develop, Area Directors require improvement
plans from regional office directors to correct problem areas.
Area Directors visit each regional office at least annually to
conduct an in-person review of operations. On-site reviews of regional
office operations are also conducted by the VBA's Compensation and
Pension Services. In addition, monthly Statistical Technical Accuracy
Reviews (STAR) provide a consistent and objective review of regional
office decision quality.
Regional office directors and individual employees alike are held
accountable for performance deficiencies. If a regional office is not
meeting performance targets, improvement plans for the office are put
in place and closely monitored. The regional office director must
identify efforts that can be taken locally to improve performance. If
productive capacity is the issue, a regional office will frequently
broker work to another regional office. If the deficiency is a quality
issue, there are several options that can implemented, often in a
complementary fashion, such as a ``Technical Assistance Team'' from the
Compensation Service; additional training provided by the STAR staff on
identified error trends; and training for local quality reviewers.
Challenged regional offices will also engage an identified high-
performing ``sister'' or ``mentor'' station to share best practices and
identify opportunities for improvement.
Claims processing timeliness is affected by factors ranging from
the regional office's workload management to the responsiveness of
outside entities. VBA has established a Workload Management Training
Program to train new supervisors in the use of reports that help in
timely decisions on workload that can enhance office performance.
As an improvement plan will involve any or all of the approaches
outlined above, the Area Director will also engage in more frequent
communication with an underperforming office. Written and electronic
communication, structured telephone calls and site visits are all used
to ensure progress toward the improvement plan targets.
If the Director cannot successfully lead the regional office to
improvement, subsequent performance action will be taken during
performance appraisal periods.
Resource Allocation Strategy to Optimize Organizational Performance
For a number of years, VBA has been pursuing a strategy to allocate
additional resources to regional offices that perform at a higher
level. This strategy was intended to increase the VBA organizational
performance and capacity to assist regional offices experiencing
workload challenges and performance difficulties due to unexpected
staffing losses or workload increases. Resource Centers have been
established at thirteen high-performing offices throughout the country,
and claims are brokered to these centers for processing. However, our
strategy to recruit and expand operations in locations where we have
demonstrated that we can be competitive and achieve high performance
levels has been impacted in recent years as a result of the dramatic
workload increases and our need to rapidly and significantly increase
staffing levels. In a number of cases, we have had to add resources to
regional offices based on the availability of space in existing
facilities rather than high performance.
This fiscal year has been challenging because VBA has been
utilizing our Resource Center brokering capacity to readjudicate
previously denied claims for newly established Agent Orange presumptive
conditions (ischemic heart disease (IHD), Parkinson's disease (PD) and
Hairy Cell (B-Cell) leukemia (HCL)). VA must adjudicate or readjudicate
approximately 147,000 claims for IHD, PD, or HCL filed by Nehmer class
members (Vietnam Veterans and their survivors) and, when appropriate,
provide retroactive benefits. Due to the complexity of readjudicating
these claims, all Nehmer readjudication claims are being processed at
VBA's Resource Centers. Our Resource Centers are therefore temporarily
not available to assist in balancing claims workload across regional
offices or support underperforming or challenged regional offices.
There has been some capacity for brokering identified in other regional
offices, and Areas have taken advantage of that to continue helping
challenged offices this year.
VA currently has 1,300 employees at Resource Centers around the
country devoted to the readjudication of Nehmer claims. There are
approximately another 1,800 VA employees across VA's 56 regional
offices that are adjudicating Agent Orange claims received after
October 13, 2009. All other regional office employees continue to
process non-Agent Orange workload.
Higher Quality and Consistency of Disability Claims Decisions
STAR is the component of VBA's quality assurance program that
focuses on improving regional office claims processing accuracy. STAR
reviews evaluate the quality of the rating decision product that VBA
provides for Veterans. From the Veteran's perspective, there is an
expectation that we understand the claim, evaluate it accurately and
fairly, and provide proper compensation under the law. The purpose of
STAR reviews is to ensure that rating decision outcomes meet these
expectations. STAR findings provide statistically valid accuracy
results at both the regional office and national level. STAR error
trends are identified and used as training topics to improve
performance.
Training continues to be a priority to achieve our performance
improvement goals, and is conducted using a variety of methods,
including a monthly national Quality Call, where the Compensation
Service's training, policy, and procedures staffs collaborate with the
STAR staff to address national error trends identified in STAR
assessments.
Regional offices are provided explanations on all error calls, and
they are required to take corrective action. On a quarterly basis,
regional offices are required to certify to VBA headquarters the
corrective action taken for all errors identified by STAR. The reported
actions are validated during the oversight visits conducted by the site
survey teams.
VBA is committed to using the error trends and accuracy findings to
improve overall quality. VBA uses nationwide error patterns identified
by STAR reviews, as well as information from other components of the
Quality Assurance Program, to adjust and develop the employee training
curricula.
All employees, regardless of training level, must receive 80 hours
of instruction annually. Instructional methods may include Training
Performance Support System (TPSS) modules, lectures, or practical
application exercises. For intermediate and journey-level employees,
the 80 hours must include 40 Core Technical Training Requirement (CTTR)
hours. These involve standardized training curricula of essential
topics and information. Employees must complete an additional 20 hours
of training from a list of standardized topics provided by VBA. The
final 20 hours may be used by regional offices to train on local issues
and areas of concern. This approach ensures that new and experienced
employees are grounded in standardized claims processing fundamentals.
Data from STAR reviews, consistency reviews, special focus reviews,
and regional office site visits are used to develop training for our
new hires, as well as our intermediate and journey-level employees.
Claims processing personnel are informed in a timely manner of errors,
and inconsistency trends, and provided with constructive feedback to
include instructions on how to avoid such errors in the future. The
error trends identified in STAR reviews provide us the information we
need to assess the effectiveness of our training programs and make
necessary adjustments. This promotes our goal of providing accurate,
fair, and consistent claims processing. Performance support training
tools allied to TPSS modules continue to show high and increasing
usage, reflecting their utility to the field. For example, the Medical
Electronic Performance Support System provides computerized visual
images of the various human body systems. It was developed with STAR
review input to assist with identifying the appropriate rating codes
associated with different body systems and to facilitate medical
examination requests.
Last month the Compensation STAR staff completed seven special
training programs for select employees from each regional office
currently responsible for performing local quality reviews. This
training was designed to help achieve consistency between national and
local quality reviews. Another training session is schedule in June for
the remaining regional offices. Additionally, specialized quality
review positions are being created in each regional office to further
drive quality improvements.
Claims Transformation Plan
We are reviewing and reengineering our business processes in
collaboration with both internal and external stakeholders, including
Veterans Service Organizations and Congress, to constantly improve our
claims process using best practices and ideas. We're relying heavily on
technology and infrastructure by deploying leading-edge, powerful 21st
Century IT solutions to create a smart, paperless claims system which
simplifies and improves claims processing for timely and accurate
decisions the first time.
VBA is working to simplify processes and reduce the burden of
paperwork for our Veterans. Improvements in efficiency and customer
service include new policies to promote the use of simple telephone
contacts with Veterans to clear up evidence questions and add
dependents, reducing requirements for second signatures in medical
reports where appropriately trained practitioners are capable of
providing health evaluations, and implementing the Fully Developed
Claims Initiative to promptly rate claims submitted with all required
evidence.
New disability benefits questionnaires are being specifically
designed to capture medical information essential for timely and
accurate evaluation of disability compensation and pension claims. VA
published the first set of these forms in October 2010 and dozens more
of these forms are in development for various disabilities. The content
of these disability benefits questionnaires is being built into VA's
own medical information system to guide in-house examinations. Veterans
can provide them to private doctors as an evidence guide that will
speed their claims decisions. The result will be more timely rating
decisions, fewer duplicated examinations, a reduced need for VA
examinations, less time needed to evaluate examination results by
claims processors, and a potential to improve rating accuracy.
Regional office performance will also be significantly improved
through the integration of rules-based processing and other calculator
tools designed to increase decision accuracy and employee productivity.
We are working on more than a dozen such logic-based calculators with
VA's Office of Information and Technology to equip VA decision-makers
with rules-based, online tools that automatically calculate evaluations
and certain award actions. VA recently completed and deployed tools for
cases regarding hearing loss and special monthly compensation. These
types of calculators free up time and create efficiencies that allow
employees to concentrate on more complex claims that require detailed
review and analysis.
Office of Inspector General
The Office of Inspector General (OIG) established its Benefits
Inspection Program in March 2009 as a major initiative to help ensure
timely and accurate delivery of Veterans' benefits and services. On May
18, 2011, the OIG issued a report, Systemic Issues Reported During
Inspections at VA Regional Offices, which identified issues at 16 VA
regional offices inspected from April 2009 through September 2010. OIG
found that VARO management teams face multiple challenges in providing
benefits and services to Veterans. As a result of the 16 inspections,
OIG made several recommendations to improve VARO operations. Of those
recommendations only four remain open.
One of OIG's recommendations was that the Acting Under Secretary
for Benefits revise the policy on evaluating residuals of Traumatic
Brain Injuries (TBI) and provide training to medical examiners
conducting TBI medical examinations to ensure compliance with current
examination requirements. VBA is collaborating with the Veterans Health
Administration (VHA) to ensure that all compensation and pension
examination providers are trained on TBI examinations. This initiative
is approximately 70 percent complete; all clinicians performing TBI
medical examinations will be trained by June 30, 2011.
OIG also recommended that the Acting Under Secretary for Benefits
develop a clear and measurable standard for timely completion of
competency determinations. VBA has determined that a 21-day standard is
sufficient for timely completion of competency determinations. This
will be measured from the date of expiration of the notification to the
Veteran to the date of completion. Guidance is currently being written
for formal distribution. Notice will also be provided and reinforced to
regional offices through regularly scheduled conference calls.
VBA is collaborating with VHA to address the remaining two
recommendations covered in the OIG's report. Our target for completion
of these recommendations is June 30, 2011.
Veterans Benefits Management System (VBMS)
VBMS is a business transformation initiative supported by
technology to improve VBA service delivery. VBMS is currently in a
developmental state with nationwide deployment scheduled to begin in
calendar year 2012.
To improve the efficiency of the claims process, VA is
transitioning to a business model that relies less on the acquisition
and movement of paper documents for benefits delivery. Phase 2 of VBMS
began in November 2010 at the Providence Regional Office. The
overarching goal of Phase 1 was the development and testing of
software, while ensuring integration with existing databases and legacy
claims processing systems. Additionally, Phase 1 focused on identifying
and correcting critical defects, optimizing scanning operations and
procedures, and developing functionality enhancements for future
iterations.
During the second quarter of fiscal year 2011, claims processors at
the Providence Regional Office began using the new software to process
a limited number of original claims for disability compensation to
validate capabilities within VBMS. The measure of success, which was
achieved for Phase 1, was the capability to enter claims into a
paperless system and process the claims to completion. As of May 18,
2011, 175 claims were established through the VBMS interface and were
being processed in a paperless environment.
Phase 2 began in May 2011 at the Salt Lake City Regional Office,
building upon the efforts and information gathered in Providence. The
Providence Regional Office will continue using VBMS to process claims
and provide recommendations for system improvements.
Phase 3 is scheduled to begin in November 2011, at a site yet to be
determined. Phase 3 is scheduled for completion in May 2012. These
successive phases validate and refine system requirements. The three
phases will be followed by a national rollout to all regional offices,
which is scheduled to begin in calendar year 2012.
VBA recognizes that technology is not the sole solution for our
claims-processing challenges; however, it is the hallmark of a forward-
looking organization. Combined with a renewed commitment and focus
toward increasing advocacy for Veterans, the VBMS strategy combines a
business transformation and re-engineering effort with enhanced
technologies, giving an overarching vision for improving service
delivery to our Nation's Veterans.
Conclusion
VBA employees in all of our regional offices are dedicated to
delivering accurate and timely benefits decisions. We recognize that
there is variance in the overall performance of our regional offices,
and we must be both vigilant in identifying shortcomings and aggressive
in correcting them. VBMS and our other claims transformation
initiatives are critical to our future success in improving the
performance of all of our regional offices. We will continue to
vigorously pursue business process and technology-centered improvements
designed to ``break the back of the claims backlog'' and achieve our
goal of processing all claims within 125 days with 98 percent accuracy
by 2015.
Mr. Chairman and Members of the Subcommittee, this concludes my
remarks. Thank you again for the opportunity to testify. I am happy to
respond to any questions.