[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
FROM THE INSIDE OUT: A LOOK AT CLAIMS REPRESENTATIVES' ROLE IN THE
DISABILITY CLAIMS PROCESS
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, APRIL 18, 2012
__________
Serial No. 112-57
__________
Printed for the use of the Committee on Veterans' Affairs
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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
MARK E. AMODEI, Nevada
ROBERT L. TURNER, New York
Helen W. Tolar, Staff Director and Chief Counsel
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
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C O N T E N T S
__________
April 18, 2012
Page
From The Inside Out: A Look At Claims Representatives' Role In
The Disability Claims Process.................................. 1
OPENING STATEMENTS
Chairman Jeff Miller............................................. 1
Prepared Statement of Chairman Miller........................ 36
Hon. Silvestre Reyes, Acting Ranking Democratic Member........... 2
Prepared Statement of Hon. Reyes............................. 37
WITNESSES
Mr. Jeffrey Hall, Assistant National Legislative Director,
Disabled American Veterans..................................... 4
Prepared Statement of Mr. Hall............................... 38
Executive Summary of Mr. Hall................................ 42
Mr. James Wear, Assistant Director for Veterans Benefits Policy,
Veterans of Foreign Wars....................................... 6
Prepared Statement of Mr. Wear............................... 43
Mr. Randall Fisher, Department Service Officer of Kentucky, The
American Legion................................................ 8
Prepared Statement of Mr. Fisher............................. 46
Executive Summary of Mr. Fisher.............................. 49
Mr. Paul Sullivan, Managing Director for Public Affairs and
Veteran Outreach, Bergmann and Moore, LLC...................... 22
Prepared Statement of Mr. Sullivan........................... 50
Mr. Tom Murphy, Director of Compensation Service, Veterans
Benefits Administration, U.S. Department of Veterans Affairs... 27
Prepared Statement of Mr. Murphy............................. 54
MATERIALS SUBMITTED FOR THE RECORD
Mr. Carl Blake, National Legislative Director, Paralyzed Veterans
of America..................................................... 55
FROM THE INSIDE OUT: A LOOK AT CLAIMS REPRESENTATIVES' ROLE IN THE
DISABILITY CLAIMS PROCESS
Wednesday, April 18, 2012
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, D.C.
The Committee met, pursuant to notice, at 10:03 a.m., in
Room 334, Cannon House Office Building, Hon. Jeff Miller
[Chairman of the Committee] presiding.
Present: Representatives Miller, Johnson, Runyan, Benishek,
Reyes, Michaud, Braley, McNerney, Donnelly, Carnahan.
OPENING STATEMENT OF CHAIRMAN JEFF MILLER
The Chairman. Good morning, everybody. Welcome to this
morning's hearing, a timely topic I am sure. We are here today
to review the veterans service organizations' roles in the
disability claims process. Initially I want to thank The
American Legion, who are here today, for bringing this topic to
the Committee's attention. This topic was noted in a letter
that was sent to me by your commander and the veterans service
officers on what the VSO's role is in the claims processing
system. I know it is integral in the claims process. I want to
begin today on a positive note in discussing some of the
tremendous parts that VSOs do play on behalf of our Nation's
veterans.
VSOs fulfill an invaluable service to our veterans by
aiding them in navigating a complex and confusing system to
receive the benefits that they have earned. As I have mentioned
numerous times in the past, and other Members of this Committee
have as well, our veterans put their life on the line to defend
our liberties and our freedom. Just as our servicemen and women
fulfilled their duty to serve and defend our country we have an
equal duty to ensure that they receive what they have earned.
VSOs are helping to fulfill this commitment everyday by helping
veterans navigate the claims process, very often enabling
veterans to obtain earned benefits. And they provide this
service free of charge. In addition, being represented
throughout the claims process is effective. Study after study
shows that veterans with representation do in fact have a
greater chance at recovering their earned benefits than if they
are not represented by a VSO, an agent, or an attorney.
I would also like to recognize a positive change in recent
years which has involved a move towards increased cooperation
and partnership between the VA and the veterans service
organizations. Placing the veteran and his or her needs at the
center of the objective facilitates the spirit of cooperation
that we are here today to examine and hopefully to improve. I
hope to see continued progress in this direction going forward.
However, part of this Committee's function is oversight,
ensuring that everything is done to assist our veterans to the
full extent that our resources can realistically permit. To
this end, and in the spirit of cooperation, it is my hope that
we can explore what can be done to improve VSO representation
throughout all stages of the disability claims process, as well
as surveying some of VBA's weaknesses in this regard. For
example, there are enormous challenges with the evolving
structure of the Veterans Benefits Administration. Most of
these changes have originated in the process of bringing VBA
into the 21st Century. These adjustments present increasing
challenges for VSOs and VBA. We have a duty to explore the
limitations of VSO resources when presented with an increased
workload resulting from these transitions, as well as the
result of sacrificing quality in working a claim due to the
sheer volume and increased complexity of the claims that they
are receiving.
I also intend to investigate some of the weaknesses in the
claims process itself with respect to the Veterans Benefits
Administration. The track record over several decades of VBA in
implementing sweeping improvements to its claims process has
been substandard. Now with two wars winding down, and an
increasingly aging veteran population, it is imperative that
the much touted technological and training improvements are set
up correctly and are used efficiently.
I have vowed that this Committee will continue vigorous
oversight to see these goals are accomplished and I reaffirm
that promise today before each of you here. And to this end I
would like to thank all of our witnesses for their attendance
at this morning's hearing as well as for their ongoing service
to our Nation's veterans.
I now turn to the Ranking Member for his opening statement.
And as you know Mr. Reyes your full statement can be entered
into the record if you choose to use a synopsis. You are
recognized.
[The prepared statement of Chairman Miller appears in the
Appendix]
OPENING STATEMENT OF HON. SILVESTRE REYES,
ACTING RANKING DEMOCRATIC MEMBER
Mr. Reyes. Thank you, Mr. Chairman. Let me add my welcome
and thanks for all your work on behalf of our veterans. Mr.
Chairman, I also want to thank you for holding this very
important hearing. Today we have many well informed
stakeholders in this room with us. I thank the VSO witnesses
for being here and I also want to thank you for your tireless
effort on behalf of our Nation's veterans.
I see today's hearing as a timely opportunity to focus on
bringing more solutions to the table about how to improve the
disability claims processing system to produce better outcomes
for our veterans. I think, Mr. Chairman, we all know what the
problem is. Over 1.3 million claims and appeals jammed in a
flawed processing system in an organization with a current
management culture that often overemphasizes production over
quality.
Well quantity over quality will not work when it comes to
our veterans. We need to get claims done right the first time,
as if a do over was not an option. There is no shortcut of
getting around the basics of having well trained employees who
are empowered with the right tools and the right systems to get
the job done right the first time. That is why I still remain
concerned that the work credit system may not keep the focus on
the veterans but on turning out work.
VA's claims backlog problems are not new and many of VA's
current ``new solutions'' have already been done in different
iterations. What is different is that we have veterans
returning home from, as you mentioned Mr. Chairman, two wars
that we hope are winding down and have serious signature
injuries like PTSD and Traumatic Brain Disorder.
At last 26 percent of our returning veterans will suffer
from one of these injuries which require a huge commitment. We
have veterans committing suicide in shameful numbers, the most
recent figure being 18 veterans every single day. That is one
veteran every 80 minutes, over 6,500 a year. That means that
before this hearing is over a veteran will have taken his or
her life. That has to break our hearts.
Having any system take the current claims processing system
where over 65 percent of claims are in backlog should also
break our heart. We need to get this right so that no claims
are languishing and that veterans, their families, and
survivors get the benefits that they have earned and deserve
without delay.
Like many of you I agree with Ranking Member Filner that VA
should remember that VA should stand for Veteran Advocate and
not Veteran Adversary. To that end I am glad that we now have a
secretary who understands that part of VA's mission is
advocacy. I understand that since passage of Public Law 110-
389, the Veterans Benefits Improvement Act of 2008, the
Secretary has been much more receptive and inclusive of our VSO
partners. He has done this by including them in meetings on
critical issues, including larger initiatives like Veterans
Benefits Management System and eBenefits. I understand that
there is even a stakeholder enterprise portal well underway
which may allow the thousands of service officers, including
our state, local, and county service officers, to have needed
access to veterans claims information.
These are all great initiatives. But simply put, much more
needs to be done. Today we have received a number of well
thought out and informed comments in the testimony that has
been submitted. I am confident that VA will take them under
serious advisement. It is up to us, Mr. Chairman, to make sure
that that happens. I warn that in order for these
recommendations to receive serious consideration it will
require a culture change at our VA. One where veterans receive
the benefit of the doubt. The VSOs along with many other
stakeholders are the veterans' advocates and VA needs to
continue to do outreach to make their voices a part of the
transformation process.
We must continue on a path to making the claims system
provided to our veterans first rate, world class, and
uncompromising. Where it has to simply be done right the first
time.
And before yielding back time, Mr. Chairman, I hope we
still include a hearing where we bring Secretary Shinseki and
Secretary Panetta together to start working on a single system
that will provide much better service both for active duty and
veterans in the whole scheme of things.
So with that thank you again for holding this hearing and I
yield back my time.
[The prepared statement of Hon. Reyes appears in the
Appendix]
The Chairman. And thank you very much for your comments
regarding Secretaries Panetta and Shinseki. We are working both
through HASC and our Committee to set the schedule. As you well
know we are working on the Defense Authorization Bill.
Mr. Reyes. Yes.
The Chairman. As soon as that is over Chairman McKeon has
said that we will schedule some times.
Mr. Reyes. Great.
The Chairman. So thank you very much. Thank you and welcome
to our first panel. We are glad to have you here today.
Our first panel consists of Jeff Hall, the Assistant
National Legislative Director for the Disabled American
Veterans.
Next we will hear from Mr. James Wear, the Assistant
Director for Veterans Benefits Policy for the Veterans of
Foreign Wars.
And finally we will hear from Mr. Randall Fisher, the
Department Service Officer of Kentucky for the American Legion.
I thank you all for being here today. We appreciate the
testimony that you will be providing to us and Mr. Hall, we
will begin with you. And you are recognized for five minutes.
STATEMENTS OF MR. JEFFREY HALL, ASSISTANT NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS; MR. JAMES WEAR, ASSISTANT
DIRECTOR FOR VETERANS BENEFITS POLICY, VETERANS OF FOREIGN
WARS; AND MR. RANDALL FISHER, DEPARTMENT SERVICE OFFICER OF
KENTUCKY, THE AMERICAN LEGION
STATEMENT OF MR. JEFFREY HALL
Mr. Hall. Thank you. Chairman Miller, Mr. Reyes, and
Members of the Committee, it is an honor to be here today on
behalf of DAV's 1.2 million members, all of whom are wartime
disabled veterans, to share some insights into the role of
service officers and our views about the ongoing transformation
of the VA's claims processing system.
Mr. Chairman, as you well know VSOs play an integral part
in the disability claims process. VSOs assist VA by reducing
its workload, ensuring claims decisions are more accurate, and
helping to improve and redesign VA's claims processing system.
Since 1920 DAV has provided free representation to all veterans
and their dependents who are seeking entitlement to VA and
other government benefits. DAV has the largest service program
with 100 national offices and approximately 240 national
service officers and 30 transition service officers who helped
file almost 250,000 claims last year alone.
DAV NSOs focus on educating disabled veterans about their
benefits and the claims process, assisting them with filing
claims for benefits, and advocating on their behalf to ensure
that they receive all of their earned benefits. One of the key
reasons for our success at DAV, and an essential element we
believe for VA to be successful, is our unwavering commitment
to our training program. To create and maintain the culture at
DAV to uphold our core values of service, quality, integrity,
and leadership every DAV service officer is required to
participate in a comprehensive training program that lasts
throughout their career. New NSOs must successfully complete a
rigorous 16-month on the job training program which includes
mandatory college courses. And new trainees are regularly
tested throughout their training to ensure the mastery of the
subject matters and operating procedures, and must also pass a
comprehensive test at the completion of their training.
After completing the initial 16 months of their training
period all of our NSOs participate in DAV's comprehensive 32-
month structured and continued training program which is
designed to provide an in depth knowledge and understanding of
VA's adjudication process as well as the VA's schedule for
rating disabilities, and the most recent changes to statutes,
regulations, policies and case law affecting veterans benefits.
By comparison, Mr. Chairman, VBA's training is much
shorter, less rigorous, and has fewer testing requirements. As
such we continue to recommend that VBA significantly increase
the hours devoted to annual training and like DAV require all
employees, coaches, and managers to undergo regular testing
that measures their job skills and knowledge as well as the
effectiveness of their annual training.
Mr. Chairman, DAV NSOs and TSOs place a strong emphasis on
the vital role claimants can play in the process by encouraging
them to be proactive in gathering as much evidence as possible,
particularly private medical records using the new disability
benefits questionnaires. We have worked with VBA to ensure the
new DBQs ensure an accurate and efficient template to capture
the relevant medical information needed to substantiate a
claim.
However, we are concerned that a longstanding cultural bias
within VBA against private medical evidence could limit the
effectiveness of the DBQs. Although the law does allow the use
of private medical evidence it does not require that it be
given equal weight the same as VA medical evidence. To address
this problem we recommend the Committee approve legislation
requiring VA give due deference to private medical evidence
that is competent, credible, probative, and otherwise adequate
for rating purposes.
DAV has also worked closely with VBA in the development of
the fully developed claims process, the new rating calculators,
evaluation builders, and simplified notification letters. We
also have regular interaction with the new IT development,
especially eBenefits, the VBMS, and the stakeholder enterprise
portal.
Overall, there is a significant change in VBA's openness to
partnering with VSOs. And Under Secretary Hickey is setting a
positive tone that will pay dividends for VBA, VSOs, and most
importantly for veterans. We have also worked very closely with
the compensation service in development their new operating
model thanks to the same commitment to partner with VSOs by
Director Tom Murphy.
Mr. Chairman, we are all aware of the significant problems
and challenges faces by VA as it seeks to reform the claims
processing system. While Congress has increased resources,
funding, and personnel over the past several years there has
also been a major increase in the number of claims filed, the
number of contentions per claim, as well as the complexity of
the rating decisions.
In closing, Mr. Chairman, the backlog of claims that are
pending is too high and the accuracy of claims decisions
remains too low. However, we must all remember that eliminating
the backlog is not necessarily the same goal as reforming the
claims processing system, nor does it guarantee that veterans
are better served. The backlog is a symptom; not the root cause
of a broken system. VBA is now in the third year of its major
transformation of the claims processing system, one that we
believe can and must be successful. We urge this Committee to
continue providing strong oversight to ensure that enormous
pressure on VBA to show quick progress towards eliminating or
reducing the claims backlog does not result in short term gains
at the expense of true long term reform.
With that this concludes my statement and I will be happy
to answer any questions you or the Committee may have.
[The prepared statement of Jeffrey Hall appears in the
Appendix]
The Chairman. Thank you very much. Mr. Wear, you are
recognized.
STATEMENT OF JAMES WEAR
Mr. Wear. Good morning. On behalf of more than two million
men and women of the Veterans of Foreign Wars of the United
States and our auxiliaries I would like to thank you for the
opportunity to testify today regarding veterans service
organizations' role in the disability claims process.
In 2011 the Veterans of Foreign Wars helped more than
97,000 veterans and survivors receive over $2 billion in
compensation and pension benefits. In addition, in fiscal year
2011, the VFW represented more than 3,700 appellants at the
Board of Veterans Appeals. Our grant rate was 30.7 percent.
This is higher than the rate achieved by attorneys and it was 8
percent higher than that attained by veterans with no
representation. These show that representation by our service
officers and appellant consultants clearly helps veterans and
their claimants submit complete claims or appeals and obtain
the benefits to which they are entitled under the law.
We provide all these services to veterans for free. We do
not take a dollar in grants or payments from the Federal
government to provide these services. We do these things
because we recognize that the laws and regulations dealing with
veterans benefits are complex, the claims process is often
difficult to navigate. We do these things because veterans have
already sacrificed for our country and whatever assistance they
receive from our government should not require additional
struggle and lengthy uncertainty.
New VFW service officers are given a 40-hour classroom
``boot camp'' where they receive intensive training on all VA
benefit programs with special emphasis on compensation and
pension. Also all 245 veterans service officers who work in VA
regional offices attend training each year. This training is
very technical in nature with heavy emphasis on topics
regarding the rating schedule. Our goal is to ensure our
service officers know VA laws and regulations as well as or
better than the employees with whom they deal daily.
Once a problem with a decision has been identified we
expect our services officers to use the facts, laws, and
regulations to convince VA to change the decision in favor of
the claimant. In all we provide approximately 80 hours of
classroom training each year for each VFW service officer,
which is almost 20,000 hours of classroom training every year
at a cost of nearly $14.5 million.
Between training conferences, our national staff is
constantly monitoring various sources of change to identify
changes that might affect veterans. We analyze these changes,
discern how they might impact veterans benefit programs, and
then notify our service officers of the change and what it
means to them. These Updates are distributed several times each
month.
It is important to understand that veterans service
organizations are advocates for veterans and partners or
stakeholders with VA. Our relationship with Secretary Shinseki
and VBA leaders has steadily improved. We have tried to
demonstrate to VA that while we are advocates for veterans and
will hold VA accountable for doing its many and varied jobs, we
are also willing to work with VA to help ensure that change
when it occurs is at least neutral in its effect on veterans.
More importantly, we seek to identify win-win opportunities,
initiatives for improvement which will help both VA and
veterans.
The VFW and representatives from the largest veterans
service organization have been meeting with VBA on numbers of
initiatives, including eBenefits, Veterans Benefits Management
System, better known as VBMS. We recognize and support VBA's
plans on expanding customer and service organization
interaction with VA. VA plans to allow claimants and service
officers to submit information and claims electronically. VA
indicates that it embraces the idea of permitting veterans to
electronically change their contact information, such as
address, or report changes in income for pension, or report
changes in their dependents. Any initiative which allows
claimants and their representatives to submit data
electronically, or to affect minor changes to awards based on
user input port-ends enhanced service to veterans and great
savings in time and money to VA.
We recognize and support VBA's plans on expanding customer
and service organization interaction with VA.
Mr. Chairman, this concludes my testimony. I would be happy
to answer any questions you or any Member may have.
[The prepared statement of James Wear appears in the
Appendix]
The Chairman. Thank you very much for your testimony. Mr.
Fisher you are recognized for five minutes.
STATEMENT OF RANDALL FISHER
Mr. Fisher. Thank you. Good morning Chairman Miller,
Ranking Member Reyes, and distinguished Members of this
Committee. Thank you for the opportunity to come before you
today to discuss the role of the service officer in the
disability claims process. I am honored to represent over 2,000
accredited service officers of the American Legion. We are the
front line soldiers in the fight to get veterans the benefits
they have earned through their service and sacrifice. In many
ways we are uniquely qualified to talk about the struggle of
these veterans because we see them face to face on a daily
basis.
As an American Legion department service officer there are
several things we focus on to make sure that we do the best
possible job for our veterans. As this Committee is surely
aware the disability claims process is pretty confusing for the
layman. Even for the people who work with this system on a
daily basis it can be pretty confusing sometimes. In the
American Legion we are veteran focused and put veterans first.
Most of our service officer veterans are closely connected to
the veterans community through spouses, sons, and daughters.
This is important because we speak the language of veterans. We
know at a glance what all the information on a DD-214 means. We
can picture exactly what is happening in a report of action
because we have been there. We also can speak to the veterans
in a language they understand.
The VA can learn from this model and hire more veterans to
work on disability claims. Too many times we talk to VA
employees who would never understand basic military concepts
like a noise involved on a flight line or an artillery range,
or that a support position like a combat engineer might be
attached to a regular infantry unit for operations in the
field. Understanding things like this is as basic as breathing
to a veteran but non-veterans miss these things routinely. VA
can do better in putting veterans in a position to help
interpret these things in files.
Secondly we put a premium on training. We do two lengthy
schools for our service officers every year in Washington, D.C.
and Indianapolis. These are multi-day conferences and the
training is intensive. We continue to train outside of that
throughout the year. I personally do school in Kentucky three
times a year for my post service officers. This is one two-day
training and two one-day trainings.
Training cannot be something that gets in the way of work.
Or if you look at it that way, you are going to be behind the
curve understanding how the claim works. Training has to be a
part of the work. You would not want a surgeon to examine your
knee if they had not been properly trained. Why would you want
anyone to examine your claim if they had not been committed to
training? There are so many topics that require constant
training. You frequently pass new laws that help the process
and we have to learn how these laws will work. VA changes
regulations and we have to learn those. The courts also rule on
cases and that changes how the system works. We get regular
training on what the courts are doing and how it changes things
because it matters.
Finally when it comes to counting our work, sure, we have
to deal with the backlog just as much as the VA does. But we
believe we can get this backlog down by doing the claim right
the first time. That means putting a little extra work on the
front-end to find the details. Sure it takes a little extra
effort but you cannot put a price on getting it right for the
veteran in front of you.
I think service officers have a lot to say because we see
these veterans everyday. We see them hurting. We see them
struggling to make ends meet. We know how this impacts the
veterans. I think it is important to remember there is a human
face on every single one of those claims. When you see it just
as one million claims you lose that personal impact.
I would like to thank you again for taking the time to hear
from us. I would be happy to answer any questions you might
have, Chairman.
[The prepared statement of Randall Fisher appears in the
Appendix]
The Chairman. Thank you very much, Mr. Fisher. The
Committee appreciates all of your testimony this morning.
And Mr. Wear, I would like to start with you first if I
can.
In your testimony you said that your trainers provide
instruction as good or better than that received by the
employees in VA and that your goal is to ensure that all of
your service officers know VA laws and regulations as well or
better than VA employees. What I would like to hear from you
is, and your opinion if you would, what specific suggestions
based on your extensive training that the VFW utilizes on how
VA could improve their training process?
Mr. Wear. First, we spend a lot of time training our people
on 38 CFR. That is the rules that the VA runs by. And we find
that when talking to some people in the regional offices are
not familiar with different aspects of the 38 CFR. I would
suggest that we need to have those people be more familiar with
the various aspects of Part 3, general regulations, and Part 4,
the rating schedule. One of the things we think is important is
that if we see something that the rating schedule provides for
that the rater might not have included we like to be able to go
up and suggest to them, ``Part 4, you know, diagnostic code for
diabetes provides such and such if you are on medication. Would
you reconsider giving him 20 percent instead of just 10 or
zero?'' We would like to be able to say, ``This is what the
rating schedule shows.'' I do not think it is fair for us to
walk up to a rater and say, ``Well we think the veteran
deserves an increase in his diabetes.'' It is important to us
to be able to say what the facts show in the file, what the
medical report says, and how that relates to the rating
schedule.
The Chairman. Why do you think they are not familiar? Is it
just interpretation? They do not know?
Mr. Wear. I think they have----
The Chairman. And any of you if you do not mind, if you
would comment on that as well?
Mr. Wear. I do think there is a lot they have to learn when
they first start working for the VA. I know I started with the
VA many years ago and it took me a long time to learn
everything. There is a huge body of information they have to
learn. What I think is important is to make sure that they have
not just gotten training on it, but somebody sat down and gave
them a test or something to see how well they learned it.
Because just because you read it does not mean you understand
it. So I think that part of this is training and then making
sure they understand it. That they have, they have grasped it
so to speak.
The Chairman. Mr. Hall?
Mr. Hall. As my colleague says, training, testing, and
accountability are the cornerstones of any organization, and
especially with an organization like VBA and the complexities
involved in the rating process. I can tell you with DAV's
training program in comparison it is 32 months, again they
start with 16 months of on the job training. And their career
begins with a couple of medical courses in college, such as
medical terminology and anatomy and physiology. That is also
continued through the structured and continued training program
that we have that is 32 months long. Each month you have a new
particular subject or module that they must not only train on
weekly, and plus do a lot of things on their own time, but also
the testing that goes long with it. They must pass the test to
be able to move on to the next module. And then at the end of
that 16 months, because it is divided in half, at the end of
that 16-month SCT program they have to take a 170-question
comprehensive test and then again with different subject matter
in the second phase of that.
Even once they complete it and they are provided the
college credits in various subjects that they are awarded that,
because of the comprehensive nature of our program the fact is
that they have to return to the training program and it is
consistently cyclic throughout their career over and again. So
in addition to the laws, regulations that James is talking
about, we also provide that in depth knowledge of anatomy and
physiology which is crucial to a rating specialist who is
looking at medical records.
The Chairman. Mr. Fisher, do you have any comments?
Mr. Fisher. I retired from the VA as a nurse manager/nurse
practitioner. So I have got some of the medical background and
when I do my schools I invite people from the hospital and the
regional office to go over claims and explain the proper
physiology of the muscles and different things. But I think a
lot of the new employees at the regional office, to give you an
example I had a veteran who had peripheral neuropathy. The
diabetic specialist at the VA had said he had peripheral
neuropathy in all extremities. That is a complication from
diabetes, so you get numbness, tingling, burning in the
extremities. And when I talked to this young lady about it she
said it does not say hands or feet. And after a while of
arguing with her I said, ``Look, it is peripheral neuropathy in
all extremities. That is anything that sticks out from the
body.'' You know? He could have gotten sexual harassment thing.
But you know turned around and scheduled the veteran for
another C&P, an exam that delayed his claim another six months.
But I think they need go to the hospitals and incorporate
training even more for these new people coming in. Because a
lot of times you have got people who are straight out of
college or are straight out of high school, they come into the
VA, and they have no idea what a veteran is, and then they have
no idea about the medical terminology involved in these claims.
The Chairman. Thank you. Mr. Reyes?
Mr. Reyes. Thank you, Mr. Chairman. And before I ask
questions I just, in full disclosure I belong to all three of
your organizations and am proud to be a member. So thank you.
The Chairman. Not just a member, a life member.
Mr. Reyes. A life member, yes. Correct. Thank you, Mr.
Chairman. But you know just last Saturday I was at a breakfast
for the Vietnam Veterans of America. And in my district I hold
a monthly meeting about veterans issues, and bring in the VA,
as well as every veteran advocate that lives and resides in El
Paso. All are welcome. And part of the continued frustration
that I hear is the issue of backlogs. And why there does not
seem to be a strategy that is able to address what now
repeatedly becomes the most frustrating part of a veteran's
effort to try to get service from the VA. I am wondering if I
can ask all three of you to comment. The VA STAR quality
reviews, are they adequate to ensure the accuracy, consistency,
and timeliness that is needed for us to get 65 percent of the
claims out of a backlog status? How can the VA, through its
quality assurance measures, in your opinion, in terms
specifically as it relates to the number one frustrating issue
for veterans, and that is having to wait in those backlogs?
Mr. Hall. I believe as equally important to STAR, if I may,
is the newly implemented quality review teams that VBA has.
While we do not have a lot of statistics on it, because it is
relatively new, being implemented across the country, these
individuals are going to be dedicated inside each VA regional
office as we understand it for, I think the ratio is
approximately one quality review team member for every 35 VSRs
and one for every 25 RVSRs, who provide an independent review
as the decisions are being made at the local level, versus STAR
which may be, you know, in a centralized location. So we are
anxious to see how quality review teams are going to fare in
the process and how they are received by VBA employees at those
local stations. So there is a lot to learn about the quality
review teams but I think it is going to be as important as
STAR.
Mr. Wear. The quality review is critical at the regional
office. You need to have the local staff looking at those cases
as early as possible, preferably as a mentor second reviewer,
to make sure that when somebody is learning the process,
whether they are a rater or a developer, that they understand
that process and they can ask somebody questions. When I first
started with the VA, I mean, I had somebody I could go and ask
questions of. And that helped reinforce it more quickly so that
I could move through and do increasingly more difficult cases.
When I became a rater we had some person to person training but
no real formal like three or four of us sitting down.
As Mr. Hall said, I had myself used up my G.I. Bill to go
to school to take a course in pharmacology, anatomy, and
physiology. So I think that the better trained the people who
are raters are on what the body does, its body systems, what do
they do, how do they interact, I think is critical. I think
that you will see a little bit of loss in productivity but you
have got to train people first. Get them up to speed and then
give them the work. I think, you know, if you just give
everybody cases then they do not know what to do with them.
They spend a lot more time wondering what to do, or who do they
ask, they ask the person they are working with, as opposed to a
mentor or trainer.
Mr. Fisher. I agree with Mr. Wear. I know the VA says it is
one VA but they are really not one VA. Being a former VA
employee, the hospital is totally separate from the regional
office and the claims area. I think they ought to have some
kind of integration of the staff from the VA hospital with the
regional office to help train these employees, especially the
new ones coming in, about the medical terminology and how to
adjudicate the issues involved. But I think it is very
important that they get this medical background included in
their training for the claims process at the regional office.
Mr. Reyes. Thank you. Thank you, Mr. Chairman.
Mr. Hall. Mr. Reyes, if I may?
Mr. Reyes. Sure.
Mr. Hall. Just quickly, as far as quality review I would
also like to say that, you know, with DAV when we, for those
claimants that we represent we go down to VA everyday,
sometimes more than one time, to review those rating decisions
as they are made. At that moment is when we can provide, before
the time they issue the decision to the veteran, because it is
our claimant that we represent we are allowed the opportunity
to review that case. That is when the first moment of quality
review really can happen. And we are able to provide that with
each and every decision that we represent.
Mr. Reyes. Great. Thank you.
Mr. Wear. In fact that is something, I think is, cannot be
highlighted enough about our service organizations having the
opportunity to look at that unpromulgated, just written rating.
We find, we find that we need to look at that. And if we catch
mistakes, and we take it back to the rater when allowed to.
Sometimes there is a lot of supervision that does not want you
to talk to the rater. But we find if we, they will say, ``Thank
you. Oh, I missed that. Oh, I did not see that.'' And then they
make a correction. And it helps our customer because their
veteran and our veteran gets a better rating.
Mr. Reyes. That is encouraging. Thank you all, and thank
you Mr. Chairman.
The Chairman. Mr. Johnson?
Mr. Johnson. Thank you, Mr. Chairman. I would first like to
commend all of you for your efforts to assist our veterans with
disability claims. Your hard work and understanding of the
claims process make invaluable differences in the lives of our
veterans and help ensure that they are receiving the benefits
and services that they have earned. I appreciate your
testimony. Thank you for being here today.
I wanted to give you an opportunity, are there any specific
challenges that your organizations are facing when assisting
veterans with disability claims that you would like to
highlight for us?
Mr. Hall. One thing that has always, I think been present,
now for the last couple of years I have been working in my
present position, but the first 17 or 18 years of my career
with DAV was spent in the field at different regional offices
working for DAV, either as a service officer or a supervisor,
an area supervisor. And I can tell you that throughout the
career, one of the things that seems to recur is a cultural
difference in VA. Now while it may be much better now today
than what it was when I first started many years ago, the fact
is, is that to truly embrace veterans service organizations and
partner with them in the truest sense, while they may be here
in Washington, D.C. at VA's central office, and we do see a lot
of that and we are very positive about a lot of the changes
that we are seeing, a lot of times that does not trickle down
to the VA regional office. And one VA regional office might get
it, one other might not. And it is no mystery or no rarity for
an NSO to say, ``Well you cannot get a claim like that through
this regional office. You are going to have to make sure that
gets sent to XYZ office.''
Mr. Johnson. So there seems to be a we/they culture?
Mr. Hall. A lot of times, sure. Yeah. I believe so. And I
think that is one of the biggest things.
Mr. Johnson. Well how can Congress and this Committee
assist you and also the VA with the claims process?
Mr. Hall. Well I think with the claims process it begins
with, we have to allow VA, with all these parts and initiatives
that are in motion right now there is no way to know exactly
what the end result is going to be, how successful something is
going to be towards whether it is reducing the backlog or the
transformation of the claims process, or modernizing the IT
system. There is just too many things in motion. And we are
anxiously awaiting to see how a lot of these things work out.
However, we believe that Congress must continue with the
aggressive oversight to ensure the enhanced training, testing,
and accountability is present throughout VA. Without it the
success is going to be very limited.
Mr. Johnson. I appreciate your comments. I have expressed
continuing concern to the VA about their information technology
infrastructure, their architecture. And we are continuing to
work on those issues.
Some of you noted in your written testimony that Secretary
Shinseki has set a goal for claims to be completed with a 98
percent accuracy standard. Now, while some regional offices may
be close to reaching that standard, others are still lagging
far behind. What suggestions do you have for ensuring that all
claims are held to at least that 98 percent accuracy standard?
Mr. Wear. Another thing that I think Congress should
continue to have oversight of is the VA needs to get the word
out to people while they are still in the service as to what we
can do for you. Veterans, servicemen after they leave service
say, ``Well, I did not know I could get help from you folks.''
We have a lot of people spread throughout the country who work
in that benefit delivery discharge to try and help these
servicemen get, find out what claims they need to do before
they get out.
You have what is called Quick Start, which it is not. It is
running many days, in some places, you know, it is running over
300 days to do a Quick Start claim. Part of this is making sure
that when the VA gets the word out to people that they have
people that can do those claims when they get them. Because the
staffing out in Salt Lake City, they do not, they do it better
than in San Diego, but San Diego's Quick Start, they need more
people. They recently added another 30 people to do cases out
there, to do the ratings. I think we will have to say, again
like Mr. Hall says, how that pans out.
Mr. Johnson. Okay. Well, thank you for your testimony. Mr.
Chairman, I yield back.
The Chairman. Mr. Michaud?
Mr. Michaud. Thank you very much, Mr. Chairman. I would
like to thank our three panelists this morning for coming
forward. My first question is for Mr. Hall. You had mentioned
you had 30 service officers that help assist and 250,000
claims. What has, what is the accuracy rate of those claims? Do
you keep a record of that?
Mr. Hall. I do not know the record of that particular
aspect of it. But we have 240 national service officers that
work inside VA regional offices and some colocated in VA
medical centers; 30 transition service officers that are
dedicated to providing transition, outprocessing, claims
assistance as they are leaving the military service. I do not
know what the answer to that is. I would be happy to look into
that with our service department and get back to you on that.
Mr. Michaud. Mm-hmm. Thank you. With the wide disparity
between claims processing centers, and you heard earlier from
the previous member, that has the VSOs, you know, claims reps
noticed a difference in policies that might speak to why some
of the claims centers are more accurate than others? And we
will start with Mr. Fisher.
Mr. Fisher. I work out of the regional office in
Louisville, Kentucky. I have noticed increased accuracy there,
but that is mainly due to the training. You can get back to
what Mr. Wear was talking about, how important, and Mr. Hall,
how important the training is for these new employees. A lot of
the employees feel like you are taking them away from their
work to go to this training. But it is so important to improve
the accuracy, that training, improve that claim and make it
right the first time. That you do not have, but I have a good
relationship, I can go to the raters, I can go to the trainers,
the coaches, and talk to them about a particular claim and
catch something before the final decision is made.
Mr. Michaud. Mr. Wear?
Mr. Wear. It is critical that our service organizations
have people in the regional offices, but also at the points
where people are getting out of service. Because we find that a
lot of servicemen, we help them go through the claim and we
look through their service medical records. And a lot of them
are just amazed, ``Well, I would not have ever thought to put
that down.'' So a lot of this is knowing what you need to do,
to look at, to put it down to help that veteran file a complete
claim. It is so important that when that servicemember leaves,
that all his service medical records go with him.
Now everybody thinks that that is a fairly easy process.
But now there is numbers of military hospitals that have
electronic records. We have taken to reminding our
servicemembers you have to get your printed records and get
them to print your electronic records so that we will have a
complete set. So when it comes out the VA can go ahead and rate
on all your medical records.
Mr. Michaud. Yeah, but the question was have you noticed a
difference in the policy that might reflect the different
centers?
Mr. Wear. I think you can ascribe that to the various
supervisors that go from office to office. I can tell you when
I worked in the VA there were certain supervisors that cared
about the quality. There were other ones that were more
interested in making numbers.
Mr. Michaud. Mr. Hall? Have you noticed a difference in
policies that might speak to the difference in accuracy?
Mr. Hall. I do not know that the difference in policies, I
will say I think it kind of comes back to cultural differences.
It depends on who the employees are at each regional office and
the, you know, from the leadership. I have worked in different
regional offices, some that were not led well. I was in Chicago
back at the time when the IG investigation took place back in
2004. And they launched a study to do the, you know, the top
high six, I think, regional offices versus the low six, and
represented versus unrepresented claimants. And I can tell you
that we could absolutely get nothing done in that regional
office at that particular time. I am glad they fared okay in
the end, but what the problem came down to it starts at the
leadership and it was a culture that went down. I think that
also then has to translate to the present time of there are
still folks out there that just do not get it. They just simply
do not understand who is applying, what the claimant is
representing as a claimant, what a VSO is as a claimant's
representative, and who they are in part of the process. And
finally erasing all of the, ``This is the way we have always
done it here,'' you know, it is a slow process.
But I think that might be a lot of the reason why you are
seeing increases, along with other things like initiatives and
things that they are doing, but it starts with the leadership
at those regional offices.
Mr. Michaud. Thank you. Thank you, Mr. Chairman.
The Chairman. Mr. Runyan?
Mr. Runyan. Thank you, Mr. Chairman. And again gentlemen,
thank you for all you do for our veterans. I want to bring up
one thing. Not only the Subcommittee I chair but also this Full
Committee and the House has passed a four-year pilot program
doing exactly what you are talking about, and it is sitting
over in the Senate. I know having conversations with Secretary
Shinseki all the time, accountability is at the top of his
list. And that program is, I think, a first step in doing
exactly what all three of you were talking about, is hold the
people that are doing these ratings accountable for what they
are doing and getting them the proper training to make sure it
does not happen again. And I just wanted to put that out there
because it truly has been addressed by this Committee.
Mr. Fisher, I asked a question of the Secretary in a budget
hearing about a month and a half ago about hiring veterans and
I have not heard a response. But the difference between the
hiring and retention also, do you have any insight into that?
Mr. Fisher. I know we talked to Mr. Shinseki several times
about hiring veterans and he made an active promise here a
couple of years ago that he was going to try and get the VA up
to the 50 percent level of veterans. The veterans are out
there. They are trained. They go to the VA hospitals. I know
for the first year or so they could actually go back to
personnel. They did not have to do it online, they could
actually go to the office and fill out an application. And now
that has kind of went by the wayside, everything has gone back
to the online, where you have to go to usajobs.gov to apply.
Except for the nursing positions, and then you can go to the
hospital directly and talk to a nurse recruiter.
I think having that personnel office open expedited hiring
veterans and made it easier for them because the usajobs is
very difficult to navigate on the computer and stuff for
applications, what you are eligible for and what jobs are open
at that particular facility.
Mr. Runyan. Is there any sense into when we do hire them do
they stay in that position? Or do they----
Mr. Fisher. Yes. I have seen, I have had several people
that I have recommended for the VA that stayed on, and been
hired in as engineering, and electricians, computers, nursing
people. But I have seen them stay on. You know, anybody that
comes in like through the CMT, the workman therapy program,
those people have difficulties because their TBIs are severely
disabled and they will have trouble with attention deficit
problems and staying in a position. So a lot of those guys are
increased disability or sent for other training. So you do have
a difficulty retraining those that are severely injured.
Mr. Wear. What you just said is one of the primary problems
the VA has. That is when they hire somebody they will spend the
time training them, then they leave. I think that part of the
process of hiring somebody is trying to find somebody who
matches whatever job you are looking for. The difficult part is
to find somebody who would make a good veterans claims examiner
or rater. You know, anywhere in that looking at claims. That is
a very difficult job and it is not one that everybody who walks
off the street, even all our veterans, might be best suited
for. So I think it is important that the VA look at how they go
about hiring people to make sure they try to match that
person's skills and abilities to the requirements of the
position.
Mr. Runyan. Thank you for that. Mr. Hall, you brought up an
interesting point dealing with the private medical evidence
versus VA medical evidence. A majority of the time is it a
private medical evidence that gets the ball rolling on a rate
adjustment?
Mr. Hall. I do not know if it is the majority of the time,
but it is a great deal of the time. And I can speak too what we
do in DAV and that is when the claim is initiated it is one of
the first things that we encourage them to do. Are you being
treated by a private doctor? Sure, we ask if they are being
treated at the VA. But when we know that they are being treated
by a private doctor we zero in on the fact that they need to
make sure that they get that medical evidence. Do everything
that they can to do it, sign release forms, whatever it is, so
that they can get that medical evidence. It would be best if
they did it before, you know which we try to encourage, before
they submit the claim so we can submit it as complete as
possible. However, that is not always the case. But the key is
to get that medical evidence. The hardship in that is once the
evidence is received by the VA if you have a rater that simply
says, ``Well, I see this private medical evidence but I think
we need to set up an examination.'' That is unnecessary to do
so. If it speaks to the disability that is being claimed, it is
credible, it is competent and, you know, provides an adequate
reason for a decision, then that is where the end of it should
be. That alone, that alone would speed up the time process in
the claim.
Mr. Runyan. Thank you. Chairman, I yield back.
Mr. Wear. If I would also jump in and add, we have talked
about DBQs, disability benefit questionnaires. The VA has
structured those so that whatever requirements out of the
rating schedule are put in there, and then a private physician
can fill it out. I think part of the reason for that is the VA
has realized that a lot of raters do not accept a private
medical statement. So to help that rater feel more comfortable
if you can have the VA doctor fill this out, or you can have a
private physician fill it out. It is the same form but it gives
them the information so that the rater cannot say, ``I think I
am going to have to order an exam.'' No, you have got the same
thing you are going to get from a VA physician if he fills out
a cardiovascular DBQ. You are going to get it from the private
physician, the same information, that you are going to get from
a VA doctor. So hopefully that prevents the unnecessary VA exam
and speeds the exam process up. Or pardon me, the claims
process, not the exam.
Mr. Runyan. Thank you. Chairman----
Mr. Fisher. Mr. Runyan? I would like to say something on
that issue, too. There was with the disability claims I know if
a veteran is going to the VA hospital and he is seeing a
specialty doctor, or he is seeing his primary care doctor, they
will refuse to write any statements regarding his disability.
They will make that veteran get scheduled for a C&P exam and
that delays the process even longer, too.
Mr. Runyan. Thank you for that.
The Chairman. Mr. McNerney?
Mr. McNerney. Thank you, Mr. Chairman. I want to thank all
the witnesses for your testimony. It is very thoughtful. It is
clear that you are interested in helping find ways forward to
improving the backlog. And I just wanted to follow up a little
bit on Mr. Runyan's question. Mr. Hall, you had mentioned that
there was VBA bias against private medical evidence. And Mr.
Wear, you said one of the things that could help is just having
the same form that was used by private medical practice to, for
a veteran. Is that something that you think would help? I mean,
getting a private physician to fill out a form is going to be a
challenge in itself.
Mr. Wear. The DBQ, disability benefits questionnaire, was
constructed by the VA. What they tried to do was take the
requirements out of the rating schedule, put it in a form that
either the VA medical doctor could do or a private medical. I
think that speaks somewhat to Mr. Hall's point about the
reluctance to accept private medical statements. So that if you
have got that same form, you know for whatever the condition
is, if that same form is filled out by a private physician then
that rater cannot simply say, ``Well I am not sure if it covers
everything.'' The form has been designed and approved by VA to
cover all the aspects of cardiovascular, or whatever the
condition is. So yes, I do think that will help speed up the
process. Because we can then give it to the veteran. He can
have it filled out. We can submit that with his claim so that
would have a complete claim because you have got something that
talks to the condition right away.
Mr. McNerney. Is that form available to the VSOs?
Mr. Wear. Yes, sir.
Mr. Hall. It is. But again, we are still at the beginning
stage of that. And to just carry over what Mr. Wear is saying,
again, due deference to the private medical evidence versus the
VA medical evidence is going to be essential. The law requires
VA to accept the private medical evidence but it does not
require them to give it equal weight as VA medical evidence. A
lot of raters know this. They could simply stand there and say,
``Well I am looking at it, but you know what? I feel that an
examination is necessary.'' Or, ``I have this VA medical
evidence over here that really kind of does not say the same
thing.'' Well from a rating, you know, from a service officer's
perspective if you have a positive balance, a balance between
positive and negative evidence in the process that places the
claim in relative equipoise and reasonable doubt must be
resolved in favor of the claimant. That is a long way of saying
simply VA needs, we need to get past the fact that they simply
accept it and actually require them to give it the proper
weight that they give VA medical evidence.
Mr. McNerney. Well my constituents are served by the
Oakland Regional Office which has one of the world backlog, the
second worst backlog record in the country. Just to illustrate
how this impacts life on the veterans, could you Mr. Hall give
me just a run down of how that additional backlog of 20 days or
60 days impacts the life of a veteran?
Mr. Hall. If they have been given a life expectancy, it
could affect that individual terribly. Now that might be an
extreme case of if the person files a claim, and even though
the VA has mechanisms in place to expedite a claim, still there
is a backlog in the expedited claims. So, but in general terms
with the claims process they should not have to wait, period.
We can all agree on that simple thing. We are hopeful that the
VA can get to their 125 days. To us more importantly than the
125 days is the accuracy in getting it done right the first
time.
There are so many things that have to take place for VA to
be successful in that, but how does it affect a claimant? Well
if it takes, an individual gets out of service and they file a
claim, they do not have a job yet, they are disabled. They are
not able to get that job. They file a claim and it is going to
take them a year, more than a year to get a decision in it? It
could mean the difference between surviving and living on the
street.
Mr. McNerney. Yeah. Okay, Mr. Wear?
Mr. Wear. I think you would find if the VA took private
medical, whether on a DBQ or just a statement on a doctor's
letterhead, and used that I would suggest they could, if it
takes 30 days to 60 days to get a VA exam, you could save that
30 days to 60 days on quite a few claims.
Mr. McNerney. Is that a regional effect as well? I mean, is
this likely to be taking place, this problem of bias against
private medical, is that likely to be part of the problem at
Oakland if it is not part of the problem at one of the more
efficient centers?
Mr. Wear. I would suggest that the private medical evidence
is an issue across the system. But some places there are other
efficiencies based upon the leadership at that other office
that may be a difference at the Oakland office.
Mr. McNerney. Okay, thank you. Mr. Chairman?
The Chairman. Dr. Benishek?
Mr. Benishek. Thank you, Mr. Chairman. Thank you,
gentlemen. I have a couple of specific questions I would like
to ask just to get started. You know, I just toured a facility
in Butler, Pennsylvania that the VSO guys, where they file a
power of attorney when they start the claim, and then they try
to follow up with the status of the claim, and then the VA says
that we need a power of attorney. And I do not know if it is a
common thing, or if it is a isolated incident. But I mean, it
ended up delaying, you know, there are all these little
individual things that seem to delay the process. And there
seems to be a process problem rather than, you know, an intent
problem. And I seem to run into that sort of thing all the time
when investigating this thing. So is that a common, do you see
that all the time?
Mr. Hall. Absolutely. And I personally thank you for that
question. Because it does speak about something that we have
struggled with I am going to say throughout the course of time,
but I know at least for the 20 years or so I have been with
DAV. That getting VA to input the power of attorney into the
system so that we can provide effective representation, which
as a byproduct will help the VA do a better job, seems to be
just a longstanding issue.
Now we are hopeful, we are hopeful that some of these
systems, and ideally like the stakeholder enterprise portal,
where we can go in, the veteran can, we can select that power
of attorney. It is automatically going to be in the system.
That will then be interconnected with VBMS and a lot of other
things. And when a veteran goes in and they file a claim
through eBenefits, as an example, they might be able to select
a representative. However, it still has to come to the
representative. The stakeholder enterprise portal in allowing
the power of attorney to be there, and then us to be able to
access the full claim from that point forward is going to be
essential.
Mr. Benishek. I appreciate that. Mr. Wear, let me ask you
another question. I think you are going to copy what Mr. Hall--
--
Mr. Wear. Yes and no.
Mr. Benishek. Well go ahead, go ahead.
Mr. Wear. The difference is when you put a power of
attorney in at the medical center the regional office also has
to put it in many different IT systems. So that if you have
somebody that puts it in at the medical center and they have to
send it over to the regional office, keep in mind if you are in
Butler it has got to get to Pittsburgh. When Pittsburgh gets it
they have got to sit down and put it into many different
benefits systems. If you miss one sometimes we will go in and
try to access it and they will say, ``Uh-uh, I am sorry, you do
not have power of attorney yet.'' So part of this is how can we
do it electronically? And how can we do it electronically to
all the systems?
Mr. Benishek. Right. One of the other questions I had was
the fact that, you know, the communication between the VSO, you
know, the representative for the claimant and the rater, do
they ever speak as the rating is going on? I mean, do they
schedule the rating at a certain time so that you can go over
them, you may be in one place and they may be in another. Well
is there some kind of a coordination to say well we have, you
know, you have explained to the rater that you are processing
the claim, we think we have the right documentation, and this
is where it is, so we can go through the claim with the rater
at the same time via the phone maybe? To try to clear these
things up so he just does not rate it no and then, you know, it
takes 30 days for you to find out about he rated it no. And
then you have got to call him and say, ``Well on page 37 is the
thing you were looking for.'' Do you understand me? To
coordinate that so it is better done? I mean, does that happen?
Mr. Wear. We are finding that the people who do development
are coming to VSOs much more often and saying, ``You know, we
need this.'' A doctor's statement, or some piece of evidence.
They will come to us and ask us to get it before it goes to the
rater so the rater will have everything.
Mr. Benishek. You mentioned that sometimes the rater and
the VSO sometimes are blocked from talking to each other by a
supervisor? I mean, how does that occur?
Mr. Wear. The people who run the service center can say to
VSOs, if you have a question they can designate a particular
person you have to go talk to, which may not be a rater. It
could be a coach, it could be a supervisor. The supervisor of
the rating team. That is not true across the country. It
varies. So there is more than one regional office where if I
have a question on a rating I can walk back to the rater and we
can talk about it right there.
Mr. Benishek. So that occurs on a regular basis then when
they are doing their rating? The VSO officer is talking to them
and walking them through the application?
Mr. Wear. By depending on which office you are in. Some you
have to go talk to the supervisor, some you can talk to the
rater.
Mr. Benishek. But that does not make much sense. I was
hoping they would do it in realtime.
Mr. Hall. I would just tell you through, with DAV, and some
of the other service organizations at the regional office,
interaction with the VA, whether it is the VSR, whether it is
somebody at the front desk, a VSR throughout the process, an
RVSR, we have constant interaction to them unless there is some
kind of prohibition which may be the case. Hopefully not
anymore, but the fact is that we have constant interaction with
the rater.
They may call me and ask, ``Listen, I am looking at Mr.
Jones' case. You know, he needs this particular type of
evidence. Can you talk to him?'' And so we will make the call
on their behalf. Or, we may get the evidence and go down and
talk to them and say, ``Listen, you know this is the kind of
the evidence that you are looking for.'' And so we do have
that. That is why beyond educating the claimant and assisting
the claimant with the claims filing part of it, where we begin
our advocacy is throughout the process in interacting.
Mr. Benishek. Well that is what is so frustrating to me, is
the process seems to be full of these little small delays that
cumulatively really make it, you know, lengthy. I guess I am
out of time, but I will yield back. Thank you. Thank you,
gentlemen.
The Chairman. Mr. Braley?
Mr. Braley. Thank you, Mr. Chairman. Mr. Wear, I want to
start with a comment you made which really upset me. I have a
long history of being involved in processing and evaluation of
impairment ratings and disability claims. And I find it
appalling that we are expecting disabled veterans to be
responsible for getting copies of their paper medical records.
And I want to make sure the Committee understands the
distinction I am talking about. We have made great strides in
moving toward electronic medical records, which are original
copies. Or they are original medical copies in an electronic
format. But there has been available for over a decade the
ability to reproduce in a digital format paper medical records.
And services have been available in the private sector for
years to provide those electronic copies instantaneously of a
paper medical record. So I cannot understand why we still pass
the burden to a disabled veteran to transmit paper records of
their medical charts to anyone, especially if they originate
from DoD or they originate from VA. Can you explain to me why
we still have that expectation with the technology that is
available to us?
Mr. Wear. There is a bit of a difference. If a veteran has
been treated at a VA medical facility, the rater or the VSR can
electronically go into that veteran's record, VA record, and
download that medical record and in fact put it right in the
rating. The difference though is that getting the electronic
record from DoD to the VA is not an easy path at this point.
Mr. Braley. And why is that? Because we have been talking
about that, Mr. Chairman, for months on this Committee, and for
years before I came onto the Committee. Why have we not
addressed that interoperability issue in a meaningful way?
Mr. Wear. Well I do not know that I am the best person to
answer why that has not happened. But we try to do is when we
are trying to help that servicemember, is that if it is not
going to get from that Fort Sam Houston to the VA we think it
is more important to get a paper copy so we can give the VA all
his complete records at that point.
Mr. Braley. But here is my point. Most of the locations
where you would be getting a paper copy come through a printer
that has scanning capabilities now that can convert that to a
PDF file and send it instantaneously to anybody who is
requesting it. And what you are saying is we should put the
burden on the wounded warrior to make sure they get a printed
copy that they get in their hand, and then they are responsible
to delivering to the person who is evaluating their impairment
claim. I do not understand why we do that.
Mr. Wear. I mean, we do have the option of doing VONAPP
where the veteran or the serviceman can file online
electronically. But I am not sure how they would go ahead and
have all their records, if they are electronic records perhaps
they can transit that through VONAPP directly to the VA. But if
they have been in service any length of time those service
records, to my knowledge DoD does not offer the scanning
feature to a servicemember that would allow that to be
electronically transmitted to the VA.
Mr. Braley. Well I can tell you it takes the exact same
amount of time to scan a paper medical record into an
electronic format as it does to copy into a paper format and
hand it to somebody. And to me a system will not be working
properly until you can sign an electronic consent form in any
location and instantaneously have those records transmitted in
whatever their original form is to the person evaluating that
claim. That is when we are going to have a much more efficient
system that takes the burden off of the applicant.
And the other point I want to make is one of the biggest
problems we have is people who are involved in this process
have very limited training and understanding of how the
impairment evaluation system works. And I just helped a young
Marine that I met on a trip to Iwo Jima who had a difficult
time understanding why his individual impairment ratings that
added up to a cumulative rating did not match his whole body
impairment. And the fact that I got a copy of his records and
it was mentioned briefly in one of the lengthy overview
documents about the process was proof to me that we have a long
way to go in making people have a deeper understanding of what
to expect when they get into the system. And we also have to
educate the people doing the evaluations so they have a much
more sophisticated knowledge base to get these claims processed
uniformly, consistently, and fairly. And with that I will yield
back.
The Chairman. Thank you very much. I appreciate you being
here. We appreciate you being here today, and you are
dismissed.
Our next panel consists of one. Mr. Sullivan, it is great
to have you here with us today. He is the Managing Director for
Public Affairs and Veteran Outreach for Bergmann and Moore,
LLC. We appreciate you being here to testify. You are
recognized for five minutes.
STATEMENT OF MR. PAUL SULLIVAN, MANAGING DIRECTOR FOR PUBLIC
AFFAIRS AND VETERAN OUTREACH, BERGMANN AND MOORE, LLC
STATEMENT OF MR. PAUL SULLIVAN
Mr. Sullivan. Good morning, and thank you Chairman Miller
and Ranking Member Michaud for being here today. NOVA is a
nonprofit organization representing more than 500 attorneys and
agents assisting tens of thousands of our veterans obtain VA
disability benefits. I am testifying here today as an employee
of Bergmann and Moore, a law firm in Bethesda, Maryland
representing veterans whose disability claims were denied
before VA and the U.S. Court of Appeals for Veterans Claims.
Partners Glenn Bergmann and Joe Moore are both NOVA members and
Joe Moore also serves on the NOVA Board of Directors.
First I would like to start by saying that NOVA truly
appreciates the recent increases in appropriations for VA and
your oversight of VA. While VA is improving in many areas, and
this should be noted, there are several other areas urgently
needing your attention.
VA's overwhelmed disability claims processing system
appears to be grinding to a halt. Last Sunday the New York
Times reported the Oakland VA Regional Office takes a
unconscionable 313 days, that is more than 10 months, to
process a new claim. A few years ago VA averaged five months
nationwide. Right now more than 1.1 million claims and appeals
await decisions at VA.
Our oral comments this morning focus on five specific
recommendations for Congress and VA to improve VA's claims
process for private practitioners and VSOs. First, NOVA urges
Congress to mandate that VA provide veteran advocates full
access to claimants' records via a secure system. Social
security already has such a system that permits viewing of the
electronic folder, uploading medical and other evidence, a
seamless transition of initial claims and appeals, and even
online responses about claim status.
Second, NOVA urges Congress to provide a point of contact,
a person that VA can name where accredited representatives can
speak to that person, the same level of access granted to the
veterans service organizations that were seated at the table a
few minutes ago. Right now VA deliberately restricts access to
representatives who are not physically located in VA regional
offices. As a consequence, non-VSO representatives have no
access to individuals within VA who can provide a status on a
claim. Attorney fee coordinators have historically attempted to
fill this void by giving information to private attorneys and
agents. However, some regional offices, such as Detroit, have
specifically instructed their attorney fee coordinators not to
respond to attorney inquiries unless the inquiry deals with a
fee issue.
Third, NOVA urges Congress to mandate that VA promptly and
accurately file time sensitive documents. These documents
include those initiating and perfecting claims and appeals, as
well as forms identifying the appointment of a veteran
advocate. Delays often result in resubmitting information.
Electronic filing would eliminate this issue altogether, as
documents would be filed in realtime. It would also eliminate
the persistent problem of misfiling or losing paper documents.
Fourth, NOVA urges Congress to mandate that VA improve the
accuracy of information provided to claimants via its toll free
1-800 number. VA's inspector general has repeatedly reported a
high incidence of response inaccuracy, further frustrating
claimants and advocates. Additional training and realtime
access is necessary to improve VA's claim information sharing.
Fifth, NOVA urges Congress to hire additional decision
review officers, DROs. Currently, regional offices only have
two or three DROs working on appeals that number well into the
thousands and continue to grow. In some cases the wait time for
a decision following an initial appeal is at least 1,100 days.
That is more than three years. We believe hiring additional
DROs would improve the appeal process time and reduce VA's
claim backlog.
In conclusion, Mr. Chairman, NOVA supports funding for VA
initiatives to computerize VA's obsolete claims processing
systems. NOVA believes our reasonable and practical
recommendations to VA's initiatives will result in veterans
receiving more timely and accurate decisions from VA. NOVA
offers to work with this Committee and VA to implement our
recommendations. Thank you. This concludes my testimony.
[The prepared statement of Paul Sullivan appears in the
Appendix]
The Chairman. Thank you very much. Mr. Sullivan, in the
beginning of your testimony you talked about the Veteran's
Choice of Representation Act that was part of the Veterans
Benefit, Health Care, and Information Technology Act of `06,
and that it works as intended. And what I would like you to do
if you would is to elaborate a little on the overall effects of
the law with respect to efficiency and helpfulness to the
veteran population?
Mr. Sullivan. Thank you, Mr. Chairman, for asking that
question. And thank you for pushing through that legislation. I
probably would not be sitting here today representing a law
firm that helps veterans if you had not done that.
What VA faces right now is a surge in demand. There is a
tidal wave of claims flooding into VA. Secretary Shinseki has
stated that the number of claims coming in has steadily risen
from 800,000, 900,000, and they expect it to eclipse one
million and beyond. That means that there is plenty of work to
go around for everyone, veterans service organizations and the
attorneys who represent veterans and other claimants on
appeals. Therefore, the ability to have attorneys assist
veterans and other claimants after there has been a denial by
VA has probably assisted with the overall health of the VA
claims process. Just imagine, if you would Mr. Chairman, what
it would be like if they were not there?
In the specific details the attorneys representing
veterans, and I am not an attorney, they have been able to act
as litigators and they act to set case law and other important
standards that VA must follow with their aggressive follow up
and representation of veterans on appeals.
The Chairman. Mr. Michaud?
Mr. Michaud. Thank you very much, Mr. Chairman. And thank
you, Mr. Sullivan, for coming here today to testify before our
Committee. You used to work at the VA. And you mentioned about
accuracy, which I think everyone on this Committee agrees with.
If you get it accurate the first time you do not have to worry
about appeals. But there is and has been a wide disparity
between the claims processing centers in the different regions.
In your opinion, why is that? What makes some centers better?
Is it because of the turnover rate? Or for instance in Maine, I
know VA is an employer of choice. People really enjoy going to
work everyday. In other facilities, actually during the BRAC
process when we dealt with the DFAS facilities, where those
facilities did not have an accuracy rate as high as they were
in Maine, in those areas they were not an employer of choice.
What do you think is some of the problems within the VA system
as far as the accuracy? And I know we heard from the first
panel training being an issue. But beyond that, what are some
of the problems? And do you feel it is different policies in
different regions?
Mr. Sullivan. Congressman, thank you for your question. The
first and most important issue is demand. The tidal wave of
claims coming into VA is placing an unprecedented demand on VA.
And frankly in my opinion VA does not have the resources to
adequately meet that demand. While working at VA I personally
briefed VA leaders starting in 2003 about the surge in demand.
And VA at that time chose to, shall we say, not pay attention
to the train coming down the tracks. And that was to the great
detriment of our veterans.
The next issue is the backlog itself. Now that there is a
backlog, in other words 1.1 million veterans and other
claimants waiting for benefits, what effect does that have on
an office? Well the policy from Washington is to often say
this. Production, production, production. Get the claims out as
fast as possible. Well what that then causes is VA employees to
take the easiest route to process a claim. That may not always
be the best route to process the claim. So when there is this
tidal wave of demand if we do not have adequate staffing the
rushing of the claims causes problems.
I can speak from one point of expertise, and I say this as
an individual who worked at VA. We actually reviewed Gulf War
claims in the early 2000s. And we found that veterans claims
were more likely to be granted under these two conditions. If
it was a low backlog at the office, and the VA employees were
trained on how to process claims.
The reverse was also true. Veterans were most likely to be
denied, like 90 percent or more denied, if there was a large
backlog at that office and there was no training on how to
process Gulf War claims. So training is very important.
And the last is streamlined regulations. VA issued a report
recently, I do not have it in front of me and this is going to
be close for a description, when VA changed the regulation on
PTSD in 2010 the error rate before that was about 25 percent or
higher. After VA promulgated the new PTSD regulation the error
rate decreased to about 10 percent. That shows that
streamlining the policies to reflect science actually improves
VA's accuracy rate.
Mr. Michaud. Thank you. And I also appreciate the fact that
you are focusing on accuracy. Because actually it is
detrimental to your agency because your attorneys actually deal
with the appeals, so there will be hopefully fewer appeals if
they are more accurate. So I appreciate you are still focusing
on the accuracy issues.
Dealing with, I mean, there are two issues here. One is the
accuracy, getting claims done on time. And I see the other
issue as dealing with the backlog that is currently out there.
How would you feel about, if you look at the VSOs, the great
work they do in helping with the claims, if the VA would have
to accept some of the claims as submitted by the VSO and we do
an audit? Because I assume from what I heard in the past that
some of the VSOs' claims are pretty accurate as they go through
the system.
Mr. Sullivan. There is that new project of the ready to
rate claims, and that moves the whole discussion in that
direction. Now NOVA does not have a position on that per se.
However, in the past when I was here testifying before with Ms.
Bilmes at Harvard University she actually suggested that as a
way for VA to overcome this huge bubble, this tidal wave of
claims that have poured in. VA does need to take a very good
look at streamlining how it does the claims process. Because
what they are doing right now, Congressman, is not working.
The Chairman. Mr. McNerney?
Mr. McNerney. Thank you, Mr. Chairman. Mr. Sullivan, one of
the very first things that you said in your spoken testimony
was the, you referred to the Oakland Regional Office. And that
is the office that serves my veterans, so it is a problem for
me personally. You mentioned also something about using science
based criteria for evaluating claims and that having a positive
impact in terms of reducing the error rate. Could you elaborate
on that a little bit? I sort of perked up a little bit since I
have a science background.
Mr. Sullivan. Yes, Congressman. In three areas, Agent
Orange, Gulf War Illness, and mental health the acts of
Congress that mandated the Institute of Medicine to do a
scientific review of the literature to see, for example, does
the defoliant poison Agent Orange, is it associated with the
medical condition? Once the IOM found an association, then VA
promulgated regulations that then streamlined the claim process
for veterans suffering from medical conditions such as prostate
cancer associated with exposure to Agent Orange during service
in the Vietnam War.
Similarly science found that deployment to a war zone is
associated with the development of Post-Traumatic Stress
Disorder. VA then, at the request of Veterans for Common Sense,
promulgated regulations that followed science.
With Gulf War Illness, Congress mandated that the Institute
of Medicine review toxic exposures and conditions related to
the War. And now VA, based on reviews by the Institute of
Medicine, has begun to list medical conditions where there is a
presumptive basis for the service-connection. That has
streamlined VA's ability to process claims.
Mr. McNerney. So would you say that there is room for
additional research at the VA that would help make our claims
results more accurate?
Mr. Sullivan. Yes, Congressman. In the area of Traumatic
Brain Injury, for example, there is now new and strong medical
evidence about it. And I believe the Institute of Medicine has
issued a report on that. And we are waiting for VA to issue
more regulations on TBI that reflect the long term disabilities
associated with veterans who survive bomb blasts in war.
Mr. McNerney. Thank you that is, the TBI bill is my bill.
So you are giving a little plug for it. You mentioned in your
testimony that you considered, what you consider to be key
components of the VBA information technology infrastructure
that may harm veterans who are represented by lawyers. Could
you elaborate on that a little bit? How is being represented by
a lawyer harming their case?
Mr. Sullivan. Congressman, in our testimony we list that
veterans service organizations who are colocated at a VA
regional office enjoy the type of direct, face to face
interaction with VA rating employees. That is very good. It is
very helpful. The veterans service organizations are doing very
great work in that area. However, there is a disconnect. In the
testimony this morning that Mr. Murphy is about to give, he
talks about great relationships with the VSOs but does not
mention that VA should also have relationships with
practitioners, attorneys and non-attorney agents accredited by
VA to provide assistance. In other words, non-VSO claims
representatives. Those representatives are forced to call the
attorney fee coordinator at the regional office for a status on
the claim. In some cases the attorney fee coordinator provides
help. In other cases the attorney fee coordinator does not
provide help. Or the attorney fee coordinator refers the
attorney to call the 1-800 number. And the 1-800 number, as we
know from VA OIG reports, is broken. So there is a difference
in the level of access by attorneys and agents to the records.
And that is why our first recommendation is to make sure that
attorneys and agents representing veterans have full and
immediate access to veterans' records. This must be a part of
VA's new computer system.
Mr. McNerney. Okay, thank you. That is all.
The Chairman. Thank you very much. Mr. Michaud, any other
questions? Thank you, Mr. Sullivan. We appreciate your
testimony.
Mr. Sullivan. Thank you, Mr. Chairman.
The Chairman. Now our third panel, Mr. Murphy. Tom Murphy,
Director of Compensation Service, Veterans Benefits
Administration for the U.S. Department of Veterans Affairs. And
Mr. Murphy, we appreciate you patiently waiting and look
forward to your testimony, sir. And you are recognized for five
minutes.
STATEMENT OF MR. TOM MURPHY, DIRECTOR OF COMPENSATION SERVICE,
VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS
STATEMENT OF MR. TOM MURPHY
Mr. Murphy. Thank you, Mr. Chairman. Chairman Miller,
Ranking Member Michaud, and the Committee, thank you for the
opportunity today to talk with you on the important partnership
between the Department of Veterans Affairs and the national,
state, and county veterans service organizations.
As VA moves into the 21st Century, this collaboration
establishes the foundation for providing veterans with the
benefits they have earned in a timely and equitable manner.
This partnership focuses on assisting veterans with filing
disability claims and receiving appropriate compensation for
service-connected diseases and injuries. Trained claims
representatives from VA recognized VSOs provide invaluable
guidance to veterans filing claims and work with employees of
the VBA to ensure that complete and accurate information is
available to facilitate correct disability and compensation
decisions. Office space is provided for these claims
representatives in all VA regional offices where they assist
with evidence development, view decisions made by VBA
employees, and counsel veterans regarding claims and appeals.
To further the collaborative effort with VSOs claim
representatives, VBA established a training program and
certification process. In 2008 the Training, Responsibility,
Involvement, and Preparation of claims program was introduced.
This TRIP program was designed to improve overall service to
veterans by instructing the representatives on the requirements
for successful claims processing and familiarizing them with
VBA computer systems. This Web-based course offers multiple
video lessons, presentations, followed by review questions. The
course helps participants learn the information needed to pass
a multiple choice final examination.
Participants have 45 days from the starting date to
complete the course, which is accessible at any time.
Successful completion of the program allows claims
representatives to be certified and have read only access to a
number of claims processing related electronic applications
that follow the development and adjudication of veterans'
claims. To date, over 4,100 service organization
representatives have registered for the course, and since 2008
3,385 representatives have completed the course by passing the
final exam. TRIP training is a critical part of VBA's goals to
improve access and transparency to the disability claims
process and thereby improve efficiency.
In addition, under VA's accreditation regulations VSOs are
required to certify every five years that each of their
accredited claims representatives continues to be of good
character and reputation and has demonstrated an ability to
represent claimants before VA. The VSOs must also certify that
each accredited representative is either a member in good
standing or a paid employee; is accredited and functioning as a
representative in another recognized VSO; or in the case of a
county veteran service officer is a paid county employee; has
successfully completed an approved course of training and
examination; and will receive regular supervision or annual
training to ensure continued qualification as a representative
in the claims process.
As the Committee is aware VBA has developed and is now
implementing its transformation plan, a series of tightly
integrated people, process, and technology initiatives designed
to improve veterans access, eliminate the claims backlog, and
achieve our goal of processing all claims within 125 days with
98 percent accuracy in 2015. We are confident that we are on
the right path to deliver more timely and accurate benefits
decisions to our Nation's veterans.
VSO involvement in our transformation plan is extremely
important, especially as we shift from a paper-based to a
paperless electronic processing system. VBA is committed to
providing service organization representatives with the tools
to assist with this transformation. VBA is developing an
electronic stakeholder entry portal. This portal will enhance
stakeholder involvement in the claims process in a secure
environment with identity access tools. VSOs will be able to
access the SEP which will facilitate the ability to assist
veterans with online completion of VA Form 21-22 as well as the
VONAPP direct connect form.
Additionally, VBA is working with service organization
representatives to implement the fully developed claim
initiative. Under Public Law 110-389, VA was directed to carry
out a one-year pilot program to assess the feasibility of
processing fully developed claims within 90 days of receipt.
Based on the favorable results of this pilot, VA expanded the
fully implemented the program across all regional offices. The
claims representatives are critical to the FDC initiative as
they assist in gathering supportive evidence for a disability
claim and helping the veteran to certify that no additional
evidence is necessary to make a decision on a claim.
Service organization representatives are an integral part
of VBA's transformation plan because of their close personal
contact with veterans. VBA constantly seeks to improve the
claims process and service organization representatives serve
an important role in that effort.
This concludes my testimony and I look forward to your
questions.
[The prepared statement of Tom Murphy appears in the
Appendix]
The Chairman. Thank you, Mr. Murphy. I applaud the attempt
to get to 98 percent accuracy within 125 days. I am somewhat
skeptical that it can be accomplished in a three-year period
especially when we hear stories like the ones from Mr.
McNerney's area where we are talking 300-plus days, a year. Why
is there such a disparity between some of these processing
offices?
Mr. Murphy. The work does not flow in as simple as, it does
not come into a single location. Each office has an assigned
territory that comes with it. So the work that flows through
that office does not necessarily change or stay constant across
the country. For example, considering Oakland, the rate of work
there may be different from the rate that comes into Togus,
Maine, or St. Petersburg, Florida. One of the effects is, how
do you keep up with the change in the rate of workflow into
that office while you are dealing with a full-time workforce
that essentially you would have to realign back and forth
across the country. The rate of claims that we receive is
moving faster than we can realign those resources. That is one
of the reasons.
The other reason is, it comes down to quality and rework in
an office. It takes longer to work a case two times, or a third
time as you are having quality issues than it does to get the
case right the first time. Which ties back to the Secretary's
initiative of 98 percent. And one of the major contributors to
decreasing that processing time is handling a case once, having
it right, and moving it out the door. That is certainly the
case that we are seeing in Oakland, for example.
The Chairman. So Oakland just gets a ton of claims and they
are all complicated? I cannot imagine St. Petersburg would not
be in the same boat, with the number of veterans that are in
that region.
Mr. Murphy. I am glad you mentioned complicated claims.
Because the complexity of the case has changed drastically in
the last ten years. If you go back and look at the history of
VA as we received a claim for a World War II veteran, for
example, it had approximately 3, 3.25 contentions. The current
veteran, a GWOT veteran, is at somewhere around 5.5
contentions. And then the difference is----
The Chairman. And why would that be?
Mr. Murphy. The nature of war today. And not only, and we
have a much better educated veteran population for one. And
then the nature of war today is bringing in complexity and it
is not as simple more contentions. It is the types of
contentions that are claimed. And the point being that
Traumatic Brain Injury and Post-Traumatic Stress Disorder,
although they count as a single contention, each, they are
significantly more complex and take significantly more time
than a relatively straightforward evaluation for a knee injury.
So the point is the number of contentions that we are receiving
on each case is climbing, and the complexity, the amount of
time it takes to accurately rate each of those contentions is
taking significantly more time.
The Chairman. Do you broker the claims that come in to
Oakland out to other facilities?
Mr. Murphy. I cannot speak specifically for Oakland.
The Chairman. Any facility. I mean, your explanation a
minute ago was we cannot move people around.
Mr. Murphy. Yes.
The Chairman. But you can move cases around.
Mr. Murphy. We do broker cases around the country, that is
correct. We have 13 what we call D1BCs, Day 1 Brokering
Centers. However I have a caveat with those. Those 13 Day 1
Brokering Centers for 14 out of the last 16 months have been
dedicated to working the three new presumptive conditions that
were granted a year ago to clear up the Agent Orange
presumptives. So those facilities are now returning back into
the regular production. So we will be able to take advantage of
some of that brokering around the country.
The Chairman. Did VA take into account the extra work that
was going to be associated with the presumptives on Agent
Orange? I mean it appears that you are trying to say that the
backlog problem is Agent Orange and the cases that are coming
in for that. Is that what is gumming up the system?
Mr. Murphy. To say that that is the sole reason, no. To say
that it is a contributing factor, yes. And I was a moment ago
talking about complexity of the claim. And I have to go back to
the 250,000 approximately cases that were just readjudicated.
It takes three times as much time for a rater to work one of
those cases as it does for one of the cases that is coming
through the traditional routing method. And to put some other
numbers around that, first so the production is .8 cases per
day as opposed to approximately 2.5 cases per day, working on
an Agent Orange Nehmer claim versus working on a traditional
claim that is coming through. And then the other part of it is,
to go back and talk about the productivity, those Day 1
Brokering Centers that I was just talking about, plus others
that were in the offices, it consumed 37 percent of our
workforce that was working claims in general. 37 percent of
those were dedicated to rating those Agent Orange claims.
The Chairman. Was VA prepared for that?
Mr. Murphy. I do not know that it is necessarily a question
of was VA prepared for it. The law requires it, therefore we
dealt with the law as it was required and laid in front of us.
The Chairman. What did VA do to prepare for it?
Mr. Murphy. I can speak from the standpoint of how we
handled the cases that were laid in front of us in terms of the
training that we put to it, and the people that we assigned to
it. And in that one I can tell that we went back in and
completely redid the entire process, starting with all of the
people that were working those cases and putting them through
an intense training program that taught them all of the
particulars around these three conditions and the requirements
that we deal with when we are working on cases that are subject
to the Nehmer court case.
The Chairman. Did the fact that you put so much emphasis on
that cause a lack of emphasis on the myriad of other things
that the raters should have been focused on?
Mr. Murphy. I would not say that it is a lack of emphasis,
because there is not a single veteran that comes through the
door that is not important to us. And the question is more a
case of how can I take care of all the veterans I have coming
into the door and not focus solely on one particular population
of veterans? And to focus on one population is not an
acceptable answer. So yes, we dedicated some people to working
on those Agent Orange claims. And then the other 67 percent of
the population worked the remaining balance of claims coming in
the door.
The Chairman. Thank you. Mr. Michaud?
Mr. Michaud. Thank you very much, Mr. Chairman. Thank you,
Mr. Murphy, for coming. You heard the previous panel talk
about, NOVA actually recommending that they have full access to
the claim records by their attorneys. Do you support that?
Mr. Murphy. Absolutely. Let me take a moment and tell you
what we are doing to make sure that that happens. We talked and
several of you mentioned earlier about the stakeholder entry
portal. The stakeholder entry portal at this point is planned
to be live before the beginning of the next fiscal year. And
with that comes access for the veterans service organizations
and attorneys that are registered with us to access the
veteran's file.
Now it is not going to roll out all in a single phase. The
first one comes out with what we call VONAPP direct connect,
which is the electronic completion of the VA Form 526----
Mr. Michaud. Well I just wanted to know if you support
their recommendations.
Mr. Murphy. Oh, I am sorry.
Mr. Michaud. So if you do, that is fine.
Mr. Murphy. Yes, absolutely. And we are putting the steps
in place to do that very thing.
Mr. Michaud. Okay. You had mentioned earlier in response to
the work load in Congressman McNerney's compared with Togus VA,
they do shift work load so if it is backlogged in Mr.
McNerney's district they shift it to Togus to help deal with
that backlog. So as far as the work load they are able to shift
that around. The concern is accuracy. And here again when you
look at the accuracy rates for those at Togus is pretty high,
has been consistently high.
Mr. Murphy. Yes.
Mr. Michaud. And the reason that I maintain is whether it
is in the VA system or Department of Defense system when you
are dealing with claims, it makes a difference about whether or
not the employees working there view that as a choice job
versus a holdover and they are moving on to somewhere else. And
so my question is, when you look at those areas that are
underperforming on accuracy, how has the turnover rate been in
those particular areas? Is it a high turnover rate in those
areas? Or do you even track that?
Mr. Murphy. I do not have the details in front of me to tie
one versus the other, and I do not know if we have done that
kind of analysis. But that is certainly one that we need to
take a look at.
As you know, we have talked about it for years, it takes us
two years to grow a new rater. So if you are trying to replace
a significant percentage of your workforce every year or every
two years, I cannot get enough journeymen in there to really
function at that high performing level. So that is a
consideration and we need to take a long hard look at our
regional offices and see if there is a correlation between
those two percentages.
Mr. Michaud. Yeah. I would be interested in seeing that
because it could have a big impact. Particularly in rural areas
where they are employers of choice they tend to do an extremely
good job because they intend to stay there versus some urban
area where it is only a holdover for maybe a couple of years
and then they move on, and that does I think reflect in the
quality of the work that is currently out there.
You had mentioned, you know, streamlining the process and I
have heard concerns actually from veterans in Maine that in the
effort to streamline the claims process more of the evaluations
will be done automatically, or automated. One example that was
given to me was that a nurse will check a box on a form that is
then read electronically. But additional notes by that nurse
may have not been used when you look at, you know, in
determining the evaluation. How can VA ensure that the
additional input from the evaluator is not considered secondary
to that checklist? And the second part of that question is how
should the VA be balancing the timeliness and uniformity with
accuracy?
Mr. Murphy. It is a great question on automation and
looking at a recommended rating decision. And I am saying it
that way because it is just that. It is not an automated rating
decision, it is a recommended rating decision based on the
evidence that is input into the system electronically. And the
key there, and this is where I have to give credit to the
veterans service organizations because we have had many
conversations on this very thing, is in the process when you
get to the end stages of it you have to have a human involved
to sit down and do the common sense test. Is this really taking
me where it needs to be? Is it really, just like you described
a moment ago, the blocks say this but the text in the bottom is
the extenuating circumstances that need to be taken into
account?
So an automated system is not going to be able to allow us
to crank through hundreds of thousands of these claims because
they are all automated coming out the other end. They have to
just get to a rater, where a rater sits and looks at the whole
case, considers the whole impact on a veteran, and then a
person makes the final decision and a rating determination. And
like I said, I have to give the credit for that one to the
veterans service organizations to make sure that we stay
veteran focused on this issue.
Mr. Michaud. Thank you. Thank you very much, Mr. Chairman.
The Chairman. Mr. McNerney?
Mr. McNerney. Thank you, Mr. Chairman. Mr. Murphy, you know
I am going to ask about Oakland.
Mr. Murphy. Yes, sir. I do.
Mr. McNerney. All right. Thank you. Your office recently
provided my office with some statistics about the Oakland
Regional Office's performance. As of last Monday the facility
had 34,756 disability claims pending, and approximate average
of 313 days. More than 80 percent of these claims sit without
rating for more than 125 days. That is the second worst region
in the Nation.
Some of this may be explainable by Mr. Sullivan's
testimony, the wave of new claims that are coming in, the
complexity of the claims. Could you give me an idea of what the
accuracy statistics might look like from the Oakland office?
Mr. Murphy. They are at 74 percent currently, in a rolling
12-month number.
Mr. McNerney. And how does that compare nationally?
Mr. Murphy. The national average is at 87 percent.
Mr. McNerney. So not only are they taking longer times, but
their accuracy is suffering.
Mr. Murphy. Let me make one additional comment on there. In
the last 90 days their quality has gone from 71 percent to 74
percent. At the same time in the last four months the national
average has gone from 84 percent to 87 percent. And the point
is that we are at a very rapid pace of increasing quality to
include that office.
Mr. McNerney. So what are you doing at that office
specifically then?
Mr. Murphy. I have to tie it back to what we have done in
terms of training, challenge training which I will talk about
in just a second, and what we have done with the quality review
teams. The challenge training, we have introduced an eight-
week, intensive, total immersion program. And out of that
program, of which there are approximately 950 new raters out in
the field, those raters are producing work at the time they
complete the training, which has all been in the last six
months, every one of these has completed 1.2 cases a day at
better than 95 percent quality out of those individuals.
Mr. McNerney. Well I can tell you, I have been confronted
by veteran constituents who are experiencing long delays. And I
tell them, ``Hey, the VA is improving.'' And they are suffering
significant personal hardship. So that is not what I want to
say, ``Well, our statistics are getting better.'' I want to
say, ``We are going to fix your case and we are going to fix it
right now.'' So I want to see more done sooner.
The VA plans on implementing its transformational system in
12 offices around the country and yet Oakland is not included
on that. Could you explain, is there a reason why Oakland was
not included on that list?
Mr. Murphy. I cannot explain that to you. I can get you an
answer for that, but I cannot explain that to you. Can I take
this in one slight different direction?
Mr. McNerney. Sure.
Mr. Murphy. And I completely understand. It is very hard to
look a veteran in the eye and tell him that you have been
waiting 330 days but you need to wait more. That is not the
message we want to give and that is certainly not the message
the veteran wants to hear. So let me take this in a slight
different direction and it is not where we are but what are we
going to do about it? And the answer is we are going to
completely retrain that office, every single person in the
service center in the month of June. We are going to run every
single one of them through an intense focused challenge
training, which yields the results of just what I was talking
about a few moments ago out of the other challenge courses. So
that performance is not acceptable to us either and we are
taking some drastic measures to ensure that it stops.
Mr. McNerney. There is no doubt in my mind that that is
your intention. And I am going to do everything I can to make
sure I keep on top of this with you. And one of the things I
want you to let me know as soon as possible, within the next
week, why Oakland was not chosen for that transformational
list?
Mr. Murphy. Yes, sir.
Mr. McNerney. If that is something that is going to improve
performance, Oakland is one of the worse performing offices in
the country, it should be considered. Have you look at the five
recommendations that Mr. Sullivan proposed for improving
performance?
Mr. Murphy. I cannot say that I have read them specifically
in what he has here, but Mr. Sullivan and I have talked in my
office on multiple occasions.
Mr. McNerney. Okay. Well I would like to see if that is, if
those recommendations are something that you are interested in.
And if so do they give us legislative ground? Do we need to do
something here to make sure that that is something that you can
move forward with?
Mr. Murphy. Okay.
Mr. McNerney. Now going back to the Oakland performance
issue, at what point does the VA, at what point does your
office take steps when you start seeing performance drop? What
is a trigger for you to start taking drastic steps to improve a
region's performance?
Mr. Murphy. I do not want to sound like I am completely
ducking the question here, because that is absolutely not the
intent. But I run the policy and procedures side of this
business. The Deputy Under Secretary for Operations runs that
particular side of the business. So I can talk in a very
general sense of what it is they are looking at and what they
are doing, but I cannot provide you the great level of detail
that you require for this. So I will take a shot at what we are
looking at.
There are national performance standards that each RO has,
that each RO director has. And through the area directors up to
the Deputy Under Secretary level each one of those numbers of
monitored and reported out each month, and you are looking for
regional offices that are underperforming as opposed to the
rest of the slate across the country. And then the area
directors then concentrate their efforts talking to that
particular regional office and addressing why their performance
is outside the norm compared to others.
Mr. McNerney. Well I would like to see some way for the
department to evaluate when a regional center is
underperforming and when steps need to start being taken to
improve performance. Mr. Chairman, I yield back.
The Chairman. Thank you very much. Mr. Murphy, with the
stakeholder entry port will caseworkers from Members of
Congress be able to access that port? We have asked time and
time again that our caseworkers be allowed to access a
veteran's case, eyes only, just to have an opportunity to see
what is in there, what is not in there, so that they do not
have to languish in somebody's file box until they make a
determination and, in Pensacola our office is probably running
a hundred cases at any given time. It would be a great asset
for us and I would think an asset for the VA to have 435 free
caseworkers looking at the case.
Mr. Murphy. That is a question I need to go back and have a
discussion with general counsel about. If it is legally
allowable to do that then we can go down a different avenue.
But I can tell you honestly that we have not really considered
that in it because we have been looking primarily at the power
of attorney, meaning NOVA and their attorneys and the veterans
service organizations that are appointed on a POA by the
veteran.
The Chairman. All of us use case work authorization forms
and they can be modified in any way to meet whatever legal
needs that VA would require. But I would appreciate if you
would look at that. Because, you know, again, usually when a
veteran comes to us they have been through the ringer for a
long time. And we want to help them solve their problem. Not
that everybody prior to us does not want to do the same thing.
But I think it would be a great opportunity for collaboration
between our branch and the executive branch to help solve some
problems, certainly not all.
Mr. Murphy. Well it certainly makes sense from the
standpoint of if one of your staff is sitting there having a
conversation with the veteran, they log in, they press a few
buttons, and rather than you send it to me and I go look at it
and come back to you two weeks later, you can give the veteran
an instant answer on the phone. So I completely understand the
value with that. And I do need, like I said, I need to discuss
with general counsel to find out what the legal restrictions or
limits may be there for us.
The Chairman. I wish you would and thank you very much. Are
there any other questions? Thank you for your testimony, Mr.
Murphy. We appreciate you being with us today. To all of the
folks that were here to testify before the Committee, we
appreciate it. I would like to ask that all Members would have
five legislative days to revise and extend or submit remarks,
and without objection so ordered. And with that being said,
this hearing is adjourned.
[The prepared statement of Carl Blake appears in the
Appendix]
[Whereupon, at 12:02 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Chairman Jeff Miller
Good morning everyone. welcome to this morning's hearing. We are
here today to review the veterans service organizations' roles in the
disability claims process.
Initially, I would like to thank the American Legion, who are here
today, for bringing this topic to the Committee's attention. as was
noted in a letter sent to me by their National Commander, Fang Wong,
Veterans Service Officers or VSO's, play an integral role in the
disability claims process.
I would like to begin today on a positive note in discussing some
of the tremendous parts VSO's play on behalf of our Nation's veterans.
VSOs fulfill an invaluable service to our veterans by aiding them
in navigating a complex and confusing system to receive their earned
benefits.
As I have mentioned numerous times in the past, our veterans put
their life on the line to defend our liberties and freedoms.
Just as our servicemen and women fulfilled their duty to serve us
and our country, we have an equal duty to ensure they receive what they
have earned.
VSO's help fulfill this commitment every day by helping veterans
navigate the disability claims process; very often enabling veterans to
obtain earned benefits.
They provide this service free of charge.
In addition, being represented throughout the disability claims
process is effective--study after study shows that veterans with
representation have a greater chance at recovering their earned
benefits than if they are not represented by a VSO, agent, or attorney.
I would also like to recognize a positive change in recent years
which has involved a move towards increased cooperation and partnership
between VA and the VSOs.
Placing the veteran and his or her needs at the center of our
objectives facilitates the spirit of cooperation that we are here today
to examine and improve.
I hope to see continued progress in this direction going forward.
However, part of the oversight function of this Committee is
ensuring everything is being done to assist our veterans to the extent
that our resources can realistically permit.
To this end, in and the spirit of the cooperative mentality I just
mentioned, it is my hope that we can explore what can be done to
improve VSO representation throughout all stages of the disability
claims process, as well as surveying some of VBA's weaknesses in this
regard. For example, there are enormous challenges with the evolving
structure of the Veterans Benefits Administration.
Most of these changes have originated in the process of bringing
VBA into the 21st century.
These adjustments present increasing challenges for VSOs and VBA.
We have a duty to explore the limitation of VSO resources when
presented with an increased workload resulting from these transitions,
as well as the result of sacrificing quality in working a claim due to
the sheer volume and increased complexity of claims received.
I also intend to investigate some of the weaknesses in the claims
process itself with respect to the veterans benefits administration.
The track record over several decades of VBA in implementing
sweeping improvements to its claims system has been substandard.
Now, with two wars winding down and an increasingly aging veteran
population, it is imperative that the much-touted technological and
training improvements are set up correctly and used efficiently.
I have vowed that this Committee will continue vigorous oversight
to see these goals accomplished, and I reaffirm this promise today. to
this end, I would like to thank all of our witnesses for their
attendance this morning, as well as for their ongoing service to our
Nation's veterans.
I now turn to our Acting Ranking Member for his opening statement.
Prepared Statement of Hon. Silvestre Reyes,
Acting Ranking Democratic Member
Mr. Chairman, thank you so much for holding this important hearing.
Today we have many well-informed stakeholders in this room with us.
I thank the VSO witnesses for being here and for their tireless efforts
on behalf of our Nation's Veterans.
I see today's hearing as a timely opportunity to focus on bringing
more solutions to the table about how to improve the disability claims
processing system to produce better outcomes for our Veterans.
We all know the problem.
Over 1.3 million claims and appeals jammed in a flawed processing
system--in an organization with a current management culture that often
over-emphasizes production over quality.
Well, quantity over quality will not work when it comes to our
Veterans.
We need to get claims done right the first time--as if a do-over
was not an option.
There's no shortcut of getting around the basics--of having well-
trained employees who are empowered with the right tools and the right
systems to get the job done right the first time.
That is why I still remain concerned that the work credit system
may not keep the focus on the Veterans but on churning work.
VA's claims backlog problems are not new and many of VA's current
``new solutions'' have already been done in different iterations.
What is different is that we have Veterans returning home from two
wars with serious signature injuries like PTSD and Traumatic Brain
Injury.
At least 26% of our returning Veterans will suffer from one of
these injuries which require a huge commitment.
We have Veterans committing suicide in shameful numbers--the most
recent figure being 18 Veterans every day. That's one Veteran every 80
minutes--over 6500 a year.
That means that before this hearing is over a Veteran will take his
or her life. That breaks my heart.
Having any system like the current claims processing system where
over 65% of claims are in the backlog also breaks my heart.
We need to get this right so that no claims are languishing and
Veterans, their families and survivors get the benefits that they have
earned and deserve without delay.
Like many of you, I agree with Ranking Member Filner that VA should
remember that ``VA'' should stand for ``Veteran Advocate'' and not
``Veteran Adversary''.
To that end, I am glad that we now have a Secretary who understands
that part of VA's mission is ``ADVOCACY.''
I understand that since passage of P.L. 110-389, the Veterans
Benefits Improvement Act of 2008, the Secretary has been a lot more
receptive and inclusive of our VSO partners.
He's done this by including them in meetings on critical issues
including larger initiatives like VBMS (Veterans Benefits Management
System) and e-Benefits.
I understand that there is even a Stakeholder Enterprise Portal
well underway which may allow the thousands of service officers,
including our state, local and county service officers to have needed
access to Veterans' claims information.
These are all great initiatives but more needs to be done.
Today, we have received a number of well-thought out and informed
comments in the testimonies.
I am confident that VA will take them under serious advisement. I
warn that in order for these recommendations to receive serious
consideration, it will require a culture change at VA--one where our
Veterans receive the benefit of the doubt.
The VSOs, along with many other stakeholders, are the veterans'
advocates and VA needs to continue its outreach to make their voices a
part of its transformation efforts.
We must continue on a path to making the claims system provided to
our Veterans first-rate, world-class and uncompromised.
Where it is done right the first time.
Thank you. I yield back.
Prepared Statement of Jeffrey C. Hall
Chairman Miller, Ranking Member Filner and Members of the
Committee:
On behalf of the Disabled American Veterans (DAV) and our 1.2
million members, all of whom are wartime disabled veterans, I am
pleased to present our views regarding the vital role that claimant's
representatives, particularly service officers from accredited veterans
service organizations (VSOs), play in the VA disability claims process.
Having spent the first seventeen years of my career with DAV in the
field working as a National Service Officer (NSO), a National Appeals
Officer, an NSO Supervisor and finally a National Area Supervisor, I
look forward to providing this Committee some perspectives learned
firsthand while assisting thousands of disabled veterans and their
dependents in obtaining the benefits to which they are entitled.
Mr. Chairman, we are all aware of the significant problems and
challenges facing the Veterans Benefits Administration (VBA) as it
seeks to make the benefits claims processing system modern, timely and
accurate. The backlog of claims pending is too high and the accuracy of
claims decisions remains too low. While Congress has significantly
increased resources, funding and personnel over the past several years,
there have also been major increases in the number of claims filed, the
number of contentions per claim, and the complexity of rating
decisions.
VBA remains focused on the goal set by Secretary Shinseki of having
zero claims pending more than 125 days and all claims completed to a 98
percent accuracy standard. And while the elimination of the backlog
will be a welcome milestone, we must remember that eliminating the
backlog is not necessarily the same goal as reforming the claims
processing system, nor does it guarantee that veterans are better
served. The backlog is a symptom, not the root cause. Just as someone
with the flu can take aspirin to reduce their high temperature, that
will not cure them of their illness, nor prevent it from returning in
the future. For example, VBA could quickly eliminate the backlog of
claims by denying all of them, or for that matter granting all of them.
However, neither option would be of benefit to veterans in the long
run. In order to achieve real and lasting success, VBA must instead
remain focused on creating a claims processing system that is carefully
designed to get each claim done right the first time.
One of the more positive developments in recent years has been the
open and candid attitude of VBA's leadership towards developing a true
partnership with DAV and other VSOs who assist veterans in filing
claims. VSOs have vast experience and expertise in claims processing,
with local and national service officers holding power of attorney
(POA) for hundreds of thousands of veterans and their families. In this
capacity, VSOs are an integral component of the VA claims process,
operating behind the firewall. Today's hearing is an opportunity to
review our role, examine ways we might further assist VBA in its work,
and offer recommendations to improve the claims process based on our
experience.
Since 1920 DAV has offered free representation to veterans, their
dependents and survivors seeking benefits and services from the
Department of Veterans Affairs (VA) and other government agencies. In
this capacity, DAV NSOs focus on educating disabled veterans about
their benefits and the claims process, assisting them with filing
claims for benefits and then by advocating on their behalf to ensure
they receive all the benefits and services they have earned through
their service. DAV and other VSOs also assist VA by reducing their
workload, ensuring more accurate claims decisions and helping to
improve and redesign VA's claims processing system.
DAV has the nation's largest service program with 100 offices
located throughout the United States and in Puerto Rico. Relying on a
corps of approximately 240 NSOs and 30 Transition Service Officers
(TSO), we provide free representation to veterans and their families
with claims for benefits from the VA, the Department of Defense and
other government agencies. In fact, DAV represents more veterans than
all other accredited VSOs combined. In 2011, DAV NSOs and TSOs assisted
nearly a quarter million veterans and their families with their claims,
obtaining approximately $6.5 billion in new and retroactive benefits.
Mr. Chairman, we firmly believe that the key to our success, and
ultimately the key to VA's success, is the steadfast commitment to
quality and accuracy in our work, and that begins with an unwavering
commitment to the education and training of our NSOs.
The primary responsibility of DAV NSOs is to function as attorneys-
in-fact, assisting veterans and their families with claims for VA
disability compensation and pension; vocational rehabilitation and
employment; education; home loan guaranty; life insurance; death
benefits; health care and much more. NSOs also represent veterans and
active duty military personnel before Discharge Review Boards, Boards
for Correction of Military Records, Physical Evaluation Boards and
other official panels. In addition, DAV NSOs conduct free informational
seminars and community outreach programs.
To develop the high level of expertise this job requires, new NSOs
begin with a rigorous 16-month on-the-job training program, conducted
by tenured supervisory NSOs with subject matter expertise. Throughout
their training, DAV closely monitors the progress and knowledge
retention of NSOs through web-based testing and monthly evaluations. In
addition to the training provided directly by DAV, NSO trainees must
also successfully complete academic instruction in Anatomy &
Physiology, Medical Terminology, Composition and/or Legal Research &
Writing, and Public Speaking, from an accredited college or university.
DAV's National Service staff is responsible for developing,
administering and monitoring the entire training program, as well as
the instructor's performance and the progress of each NSO trainee.
NSOs trainees who have successfully completed the first four months
of training, and passed the requisite tests and other evaluations, will
begin performing supervised claims work in their fifth month. They will
continue working on their individual caseload, while continuing to
receive training and instruction, and must pass a comprehensive web-
based examination every four months on the topics covered for that
given period. At the conclusion of their 16th month on the job, they
will be required to pass a comprehensive web-based examination covering
all of the topics from the entire training period.
However, DAV training is not only provided to new NSOs as they
first learn the job, rather DAV training programs are a lifelong
commitment to achieving excellence throughout an NSO's career. Beyond
their initial 16 month training, all NSOs must participate in a
comprehensive Structured and Continuing Training (SCT) program designed
to keep them up-to-date on changes to the laws and regulations
affecting veterans' benefits. This training includes not just all NSOs,
but also all Supervisors and Area Supervisors.
DAV's SCT program provides in-depth review of laws, regulations, VA
M-21 and similar manuals, VA Fast Letters, Board of Veterans' Appeals
practices, as well as opinions of the VA Office of the General Council
and holdings from the US Court of Appeals for Veterans Claims.
Moreover, the DAV SCT program delves deeply into the VA Schedule for
Rating Disabilities (VASRD) by providing a meticulous breakdown of each
anatomical system and correlating diagnostic codes and ratings. When
dealing with the complexities of the VASRD, the SCTs accompanying CD-
ROM collection, Special Monthly Compensation ``slide rule'' and case
studies prove to be extremely useful throughout the NSO's career. In
fact, there are many outside DAV who have benefited from our SCT
program; this includes other VSOs and VA employees, as well as DoD
Physical Evaluation Board members, who have utilized our SCT materials
to enhance their knowledge.
All NSOs are required to take pre-tests and then successfully
complete 32 monthly training modules with post-testing requirements for
each module. At the end of each month, NSOs must successfully pass web-
based testing in order to move forward in their training. At the end of
each 16-month period, a comprehensive 160-question web-based test must
be passed in order to move forward to the second 16-month training
period, which is delivered in the same manner as the first 16-month
period. Once an individual successfully completes the entire 32 months
of SCT training, NSOs have gained a wealth of knowledge and become more
proficient in their duties. In addition, DAV is the only VSO whose
training program has been certified for college credit by the American
Council on Education (ACE), which awards 12 college credits to our NSOs
upon successful completion of the first 32 months of SCT training.
However, DAV SCT does not end there, but will continue throughout
an NSO's career at DAV. When an NSO completes the entire 32-month SCT
program, they then start the entire training cycle again from the
beginning, but with the changes, updates and new information that is
provided by DAV's national training staff who constantly monitor and
update the course materials. By the time an NSO has 15 years of
service, they will have completed the SCT training regimen four times.
We are certain that the high quality of the services we offer are
directly related to the emphasis we place on lifelong learning for all
of our service officers.
By comparison, the VBA training program for its employees,
particularly Veterans Service Representatives (VSRs) and Rating
Veterans Service Representatives (RVSRs) is shorter, less rigorous and
has fewer testing requirements. It begins with an initial orientation
phase at Regional Offices where new employees will undergo eight weeks
of ``Challenge'' training providing them a basic introduction to their
job responsibilities. Although ``Challenge'' training had been four
weeks long, a couple of years ago it was expanded into a more intensive
eight-week course conducted at a central training academy near
Baltimore, Maryland. Recently, however, VBA stopped sending new
employees to the training academy due to budget constraints on travel,
and instead is now conducting the training locally, relying on a cadre
of trainers to conduct and/or oversee the training at each RO. While
there is certainly merit in a ``train the trainer'' approach,
centralized training of new employees has unique benefits suited to the
current transformation taking place at VBA. In addition to providing a
more focused environment for new trainees to learn their roles and
responsibilities, it allows a more consistent transmission of new
cultural values to trainees, particularly the paramount importance of
quality and accuracy. We have concerns that this change was made
strictly for short term financial considerations rather than to achieve
the long-term goal of reforming the claims processing system.
Since expanding the ``Challenge'' training to eight weeks, VBA's
policy is to have new VSRs and RVSRs immediately begin working on
claims after they complete their initial training, although they will
continue receiving both on-the-job training and mentoring from more
senior employees in their RO. They also continue with a required course
of online learning through VBA's Training and Performance Support
System (TPSS) on subjects such as how to utilize VBAs computer-based
programs, medical terminology, how to review and interpret medical
evidence, as well as understanding and applying the law and regulations
when evaluating evidence and rendering decisions. After they have
completed all of the TPSS modules for new employees, they will then
have the same continuing training requirements as all VSRs and RVSRs,
which consists of 85 hours of annual training. While there are tests
conducted during the initial training, and there is also a one-time
certification examination required for all VBA employees, there is no
regular testing performed to measure the effectiveness of annual
training, nor is there any other regular testing of employees to ensure
that they have the knowledge and skills required to successfully
perform their jobs, or to identify individual or systemic deficiencies
in the claims processing system.
Considering the complexity of their jobs, and in order to build a
culture of accuracy and quality, VBA must ensure that employees
complete all of their training requirements, and must take steps to
ensure that they have adequate time to do so. DAV continues to
recommend that VA significantly increase the hours devoted to annual
training for all VSRs, RVSRs and Decision Review Officers (DROs). In
addition, we believe it is essential that all VBA employees, coaches,
and managers undergo regular testing to measure job skills and
knowledge, as well as the effectiveness of the training. At the same
time, VBA must ensure that certification examinations as well as any
other tests that are developed accurately measure the skills and
knowledge needed to perform the work of VSRs, RVSRs, DROs, coaches, and
other managers.
Due to DAV's training program, our NSOs fully understand VA
benefits and the disability claims process. Possessing in-depth
knowledge of pertinent laws, regulations and specific holdings brought
forth by the United States Court of Appeals for Veterans Claims, DAV
NSOs educate, assist and advocate for veterans, their families and
survivors in seeking earned VA benefits. Whether an individual claimant
visits a DAV National Service Office, Transition Service Office or a
Mobile Service Office, or corresponds by telephone, mail or e-mail, our
first interaction with claimants is meant to educate them about their
rights, their benefits and the process of filing claims. We begin by
educating a claimant about the benefits to which they are entitled, the
disability claims process, and most importantly, the evidence needed
for a successful claim. DAV NSOs and TSOs place a strong emphasis on
the vital role claimants can play in this process by encouraging them
to be proactive in gathering as much of the evidence as possible. In
particular, DAV has worked closely with VBA to promote the Fully
Developed Claims (FDC) process to our clients, where appropriate.
Although earlier in the rollout of the FDC program DAV and other VSOs
had concerns about informal FDC claims, VBA worked with us to develop
and issue clear guidance on how to establish informal claims under the
FDC program.
DAV also encourages all of our claimants, if possible, to seek
private medical evidence to bolster their claims through the use of new
Disability Benefits Questionnaires (DBQs), rather than waiting for a VA
examination to be scheduled and performed. This is another area where
VBA has been highly responsive to VSOs, allowing us to review and make
recommendations to improve the format and content of DBQs. However a
cultural bias within VBA against private medical evidence could limit
the effectiveness of DBQs. Although the law allows the use of private
medical evidence, it does not require that it be given equal weight to
VA medical evidence. As such, we continue to hear reliable reports that
many VSRs and RVSRs continue to discount medical evidence or properly
completed DBQs from private doctors, instead ordering unnecessary VA
examinations, further delaying the process and adding to VBA's burden.
In order to encourage the use of private medical evidence, Congress
should amend title 38, United States Code, Sec. 5103A(d)(1) to provide
that, when a claimant submits private medical evidence that is
competent, credible, probative, and otherwise adequate for rating
purposes, including a private medical opinion submitted on a DBQ, the
Secretary shall not request a VA medical examination. With this new
language, VA would not have to accept private medical evidence if, for
example, VA finds that the evidence is not credible and therefore not
adequate for rating purposes.
DAV NSOs directly assist claimants for whom we hold power-of-
attorney (POA) in completing all the necessary forms for a successful
claim. We work with claimants to protect the date of their claim,
gather and assemble the evidence required to be awarded benefits,
complete all of the required filing forms, and submit memoranda or
written argument to accompany and support their claims application. In
fulfilling these duties, our NSOs improve the quality of the claims
filed, thereby reducing the workload on VBA. We also reduce the burden
on VBA's contact offices by interacting with veterans seeking routine
information or updates on the status of their claims.
DAV NSOs will continue to advocate for our claimants with VBA
throughout the claims process. Working directly in VBA Regional
Offices, NSOs are given 48 hours to review all rating decisions of our
clients prior to their issuance, which allows us an opportunity to
interact with the decision makers (RVSRs, DROs and/or RO management) in
order to advocate for accurate rating decisions. In this role, we act
as a comprehensive quality control check for VBA, reviewing every
rating decision affecting veterans for whom we hold power-of-attorney.
This will be even more important as VBA becomes fully engaged in their
streamlined rating decisions and notification process known as the
Simplified Notification Letter or SNL. By catching errors at the RO,
where they can more easily and quickly be corrected, we not only serve
our clients, we also save VBA the time and resources they would
otherwise have expended on lengthy and burdensome appeals.
There is substantial evidence demonstrating that represented
veterans receive better and more accurate outcomes than those without
representation. For example, veterans represented at the Board of
Veterans' Appeals in FY 2011 were awarded benefits 29 percent of the
time compared to unrepresented veterans who succeeded less than 23
percent of the time. Studies have also shown that the average award is
higher for represented veterans than those without someone to advocate
on their behalf. In May 2005, VA's Office of Inspector General (VAOIG)
issued a report (05-00765-137) examining variances in disability
compensation payments amongst the fifty states. The VAOIG report found
that the average compensation for represented veterans was $10,631
compared to an average of only $4,406 for unrepresented veterans. As
stated in the OIG findings:
``Qualified POA representatives provide a valuable service to
applicants by explaining VA benefits, assisting in completion of forms
and collection of evidence, monitoring the progress of the claim, and
representing them in hearings and appeals. The majority of veterans
receiving compensation have appointed POA representatives.''
In addition to directly helping improve the quality of claims
decisions, DAV and other VSOs have been able to help VBA improve and
redesign their claims process. Over the past few years, we have worked
increasingly close with VBA on a number of their transformation
initiatives. We have offered our expert advice to improve DBQs, the
Veterans Benefits Management System (VBMS), the Stakeholder Enterprise
Portal (SEP), e-Benefits, the FDC program, and many other pilots taking
place at ROs across the country. We have and will continue to work with
VBA as they complete the redesign of the new operating model so that
claims are accurately processed and adjudicated the first time.
VBA faces a daunting challenge of comprehensively transforming the
way it processes claims for benefits in the future, while
simultaneously reducing the backlog of claims pending within its
existing infrastructure. While there have been many positive and
hopeful signs that the VBA is on the right path, there will be critical
choices made over the next year that will determine whether this effort
will ultimately succeed. It is essential that Congress provide careful
and continuing oversight of this transformation to help ensure that the
VBA achieves true reform and not just arithmetic milestones, such as
lowered backlogs or decreased cycle times.
In order to drive and sustain its transformation strategies
throughout such a massive organization, VBA must change how it measures
and rewards performance. Unfortunately, most of the measures that VBA
employs today are based primarily on production goals, rather than
quality. This bias for speed over accuracy has long been VBA's cultural
norm, and it is not surprising that management and employees today
continue to feel a tremendous pressure to meet production goals first
and foremost. While accuracy has been and remains one of the
performance standards that must be met by all employees, new
performance standards adopted over the past two years appear to have
done little to create sufficient incentives to elevate quality above
production.
After two years of development, VBA's new VBMS IT system is planned
to begin rolling out nationally in the next couple of months. The VBMS
is designed to provide a comprehensive, paperless, and rules-based
method of processing and awarding claims for VA benefits, particularly
disability compensation and pension. As VBA turns the corner on VBMS
development leading to deployment, it is imperative that Congress
provide full funding to complete this essential IT initiative. In
today's difficult fiscal environment, there are concerns that efforts
to balance the federal budget and reduce the national debt could result
in reductions to VA programs, including IT programs. Over the next year
Congress must ensure that the funding required and designated for the
VBMS is protected from cuts or reprogramming, and spent as Congress
intended.
One area of concern that remains unresolved is how VBA plans to
handle legacy paper claims in the new VBMS work environment. While VBA
is committed to moving forward with a paperless system for new claims,
it has yet to finally determine how to handle reopened paper claims;
specifically, whether, when, or how they would be converted to digital
files. Because a majority of claims processed each year are for
reopened or appealed claims and because files can remain active for
decades, until all legacy claims are converted to digital data files,
VBA could be forced to continue paper processing for decades. Requiring
VBA employees to learn and master two different claims processing
systems--one that is paper-based and the other digital--would add
unnecessary complexity and could negatively affect quality, accuracy,
and consistency.
While there are very difficult technical questions to be answered
about the most efficient manner of transitioning to all-digital
processing, particular involving legacy paper files, we believe the VBA
should do all it can to shorten the length of time this transition
takes to complete, and should provide a clear roadmap for eliminating
paper files, one that includes clear timelines and resource
requirements. While this transition may require significant upfront
investment, it will pay dividends for the VBA and veterans in the
future.
Mr. Chairman, this will be the third year of the VBA's current
effort to transform an outdated, inefficient, and inadequate claims-
processing system into a modern, automated, rules-based and paperless
system. VBA has struggled for decades to provide timely and accurate
decisions on claims for veterans benefits, especially veterans
disability compensation, however despite repeated prior attempts to
reform the system, VBA has never been able to reach the goals it has
set for itself. Critical to VBA's success will be the choices made this
year, and it is absolutely essential that Congress continue to provide
strong oversight to ensure that the enormous pressures on VBA to show
progress toward eliminating or reducing the claims backlog does not
result in short-term gains at the expense of long-term reform.
That concludes my statement and I would be happy to answer any
questions from you or other members of the Committee.
Executive Summary
Veterans service organizations (VSOs) play an integral
part in the disability claims process, with local and national service
officers holding power of attorney for hundreds of thousands of
veterans and their families. VSOs assist VA by reducing its workload,
ensuring claims decisions are accurate, and helping to improve and
redesign VA's claims processing system.
DAV offers free representation to all veterans, their
dependents and survivors seeking VA and other government benefits. DAV
has the largest service program with 100 national offices, and a corps
of approximately 240 National Service Officers (NSOs) and 30 Transition
Service Officers who helped file almost 250,000 claims last year.
DAV NSOs focus on educating disabled veterans about their
benefits and the claims process, assisting them with filing claims for
benefits and advocating on their behalf to ensure they receive all
their earned benefits. Evidence shows that represented veterans receive
more accurate outcomes with higher average awards than unrepresented
ones.
The key to DAV's success, and ultimately the key to VA's
success, is a steadfast commitment to quality and accuracy of our work,
which begins with an unwavering commitment to the education and
training of our NSOs.
The Veterans Benefits Administration should significantly
increase the hours devoted to annual training and require all
employees, coaches, and managers to undergo regular testing that
measures their job skills and knowledge, as well as the effectiveness
of the training itself.
In order to encourage the use of Disability Benefit
Questionnaires, Congress should amend title 38, United States Code,
Sec. 5103A(d)(1) to provide that due deference is provided to private
medical evidence that is competent, credible, and adequate for rating
purposes.
In order to drive and sustain its transformation
strategies, VBA must change how it measures and rewards performance to
emphasize accuracy and quality over production.
Congress must ensure that the funding required and
designated for the Veterans Benefits Management System is protected
from cuts or reprogramming, and spent as Congress intended.
VBA must transition as quickly as feasible to a fully
digital processing system, which may require significant upfront
investment, but will pay long term dividends for veterans.
Prepared Statement of James D. Wear
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE:
On behalf of the more than 2 million men and women of the Veterans
of Foreign Wars of the United States (VFW) and our Auxiliaries, I would
like to thank you for the opportunity to testify today regarding the
Veterans Service Organizations' role in the disability claims process.
In 2011, the Veterans of Foreign Wars (VFW) helped more than 97,000
veterans and survivors receive over $2 billion in compensation and
pension benefits. In addition, in FY 2011 the VFW represented more than
3,700 appellants at the Board of Veterans Appeals. Our allowed rate
(one or more issues granted on appeal) of 30.7 percent was second
highest among the major veteran service organizations. Our allowed rate
was higher than that achieved by attorneys. It was fully eight
percentage points higher than veterans who had no representation.
We are proud of these achievements. They show that representation
by our service officers and appeals consultants \1\ clearly helps
veterans and other claimants perfect their claims and obtain the
benefits to which they are entitled under the law.
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\1\ Accredited VFW employees are called ``service officers'' and
``claims consultants''. In practice, the only distinction is that a
``service officer'' is a veteran who is also a member of the VFW; a
``claims consultant'' is an individual who is not eligible for
membership in the VFW. Their representational duties are the same. For
simplicity sake, ``service officer'' in this testimony refers to both
positions.
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However, we are not alone in this work. The American Legion,
Disabled American Veterans and the Veterans of Foreign Wars represent
nearly 1.6 million veterans and survivors already receiving
compensation, pension or DIC from VA. Together, we represent tens of
thousands more with claims and appeals awaiting decisions from VA.
As part of this process, we answer millions of telephone calls and
emails a year. We interview hundreds of thousands of individuals
annually, explaining what benefits they may or may not be entitled to,
help them complete forms, assist in developing claims, review VA
decisions, identify errors, and work with VA to get them corrected.
We provide all these services to veterans and the VA for free. We
do not take a dollar in grants or payment from the Federal government
to provide these services. We do these things because we recognize that
the laws and regulations dealing with veterans benefits are often
complex; the claims process is often treacherous to navigate. We do
these things because veterans have already sacrificed for our country
and whatever assistance they receive from our government should not
require additional struggle and turmoil.
We readily acknowledge that nearly all VA employees are dedicated
to doing the very best they can for veterans, we also realize that they
are, at present, overwhelmed with over 1.5 million pending
compensation, pension and education claims, and over a quarter of a
million pending appeals. \2\ They are people working within an
extraordinarily complicated and frequently archaic claims processing
system. Since there are few automated quality controls, they are
dependent on both how much they know and how well they apply it to
their work. In short, VA decision makers are human; they make mistakes.
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\2\ Monday Morning Workload Report, April 9, 2012, http://
www.vba.va.gov/reports/mmwr/
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Quality of decision-making is problematic. A review of the latest
quality data for ratings indicates that the best regional office
(Lincoln, NB) has a four percent error rate. The national average has
remained nearly stationary at 16 percent for months. Recent changes in
the Baltimore regional office, still the worst in the nation, have
resulted in significant improvement (for it); errors occur in ``only''
29 percent of its rating decisions, down from a 33 percent error rate
just a few months ago.
The VFW has nearly 1,300 accredited individuals. Most of these are
county and state employees who provide assistance to veterans and
survivors who have given the VFW their power of attorney (POA). Service
officers employed by the VFW and work within VA regional offices number
245. This is the group that receives specialized training and routine
information dissemination from our national office in Washington
concerning changes in law, regulations, VA procedures or court
decisions.
New VFW service officers are given a 40 hour classroom ``boot
camp'' where they receive intense training in all VA benefit programs,
with a special emphasis on compensation and pension. They are also
taught representational skills; they learn about the appeal process. We
give them the basic knowledge they need to intelligently discuss
disability and survivor benefit programs with claimants, help them fill
out appropriate forms, tell them what evidence is needed to complete
their claim, outline the claims process within VA and other things.
Training does not stop there. Every VFW service officer who works
within a VA regional office is required to attend training each year.
This training is very technical in nature, with a heavy emphasis on
topics related to the rating schedule. Most of our trainers are
recently retired VA subject matter experts who provide instruction as
good as or better than that received by VA employees. Our goal is to
ensure our service officers know VA laws and regulations as well as or
better than the VA employees with whom they deal with in their offices.
Once a problem with a decision has been identified, we expect our
service officers to use the facts, laws and regulations to convince VA
to change the decision in favor of the claimant.
In all, we provide approximately 80 hours of classroom training
each year to VFW service officers who work within VA regional offices.
\3\
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\3\ In VA Fast Letter 11-04, VBA mandated 85 hours of continuing
education for their claims processers. Unlike our training, only a
portion of VBA's mandatory training is classroom training.
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Change does not stop between training conferences. The Veterans
Benefits Administration (VBA) frequently adds or modifies regulations
and policies dealing with its benefit programs. The VA Office of
General Counsel, the Court of Appeals for Veteran Claims, the Court of
Appeals for the Federal Circuit and others publish decisions which
change how VA works. Our national staff is constantly monitoring the
various sources of change to identify those things which may affect
veterans. We analyze these changes, discern how they might impact
veterans benefit programs and then notify our service officers of the
change and what it means to them. These Updates are distributed several
times each month. This is how we keep our service officers up to date.
Veteran service officers offer a host of services to veterans,
dependents and survivors. While each claimant is different and has
different needs, the veteran service officer performs the following
roles:
Information dissemination--Generally, the first contact a
service officer has with a claimant is either in person or on the
telephone. The veteran has questions, concerns or problems. The service
officer must identify each issue and provide the most accurate
information available. Veteran service officers often perform outreach,
meeting groups wherever they might gather. This typically involves
talking about the things which are likely to interest the group, then
taking specific questions after the conclusion of his remarks.
Claims intake and preparation--This can be done either in
person or on the phone. It is most effective when the claimant can sit
down with the service officer. This allows the service officer to
review available records as the application for benefits is being
completed. The service officer asks questions and helps the claimant
focus the issues. It is also an opportunity to begin to discussing what
evidence is needed to perfect the veterans claim.
Facilitator/aid in development--A well trained service
officer will usually know what evidence the VA needs to favorably
consider the claim. He/she should tell the veteran what that evidence
is and explore with him just how that evidence can be obtained. This is
also an opportunity to begin to manage expectations of the claimant.
Problem resolution--informal intermediary to clarify
issues, obtain evidence--VA employees know who the good service
officers are, and they use them to help expedite claims. It is not
unusual for a VA employee to alert a service officer of the need for a
particular piece of evidence in order to make a decision (e.g., ``If
you obtain this piece of evidence, I think I can grant the claim.'')
This type of communication acts as an incentive for both the service
officer and the veteran to obtain that evidence and submit it quickly.
This type of informal interaction becomes a win-win for VA and
veterans.
Final quality control of VA decisions--Long established
VBA policy requires that proposed rating decisions be provided to
service officers holding veterans power of attorney for at least two
business days. During that period service officers have an opportunity
to review not just the rating, but also the record on which the rating
was based. Any errors identified during this review are brought to the
attention of either the rater who made the decision or a designated
supervisor. This process is designed so that errors can be corrected
before the rating is sent to the veteran. While some local VA managers
occasionally try to reduce or eliminate this review period, VBA
leadership has always recognized the importance of this step and have
taken corrective action when necessary.
Counselor/interpreter of VA decisions--Not every decision
made by VA is favorable to veterans. There are times when the evidence
and the law do not allow VA to grant the benefit sought. One of the
jobs of a service officer is to explain decisions to claimants in ways
that they will understand. They discuss the problem which forced VA to
deny the benefit sought and explain what evidence is necessary to
obtain a different decision in the future.
Appellate counselor--Sometimes the VA just makes a wrong
decision. When that happens the service officer discusses appellate
options with the claimant and helps him/her file a notice of
disagreement when appropriate. During the appeal process the service
officer may discuss the case with a Decision Review Officer, represent
the veteran on appeal and write an argument on behalf of the claimant
to the Board of Veterans Appeals.
Representation at the BVA--The national Veterans of
Foreign Wars maintains a staff of highly trained appeals consultants at
the Board of Veterans Appeals. Their job is to review the case when it
comes to the Board, formulate the best possible argument on behalf of
the appellant. They also represent appellants in personal hearings
before Veteran Law Judges at the Board. As mentioned above, we helped
appellants obtain reversals by the Board in 31.7 percent of the appeals
considered in 2011.
VA is in the midst of tremendous change. Historically,
technological advances in VA have been done in fits and starts. Three
phase plans often failed to move beyond the second phase. Even when new
programs were rolled out in the last two decades, they were often
deployed long before adequate testing was completed, leaving users in
the field with programs which required thousands of man-hours to fix.
However, VBA appears to be moving forward today with IT programs
which promise to speed processing while finally introducing tools which
promise to improve quality. We welcome this progress. We hope that VA
has learned lessons from its past and from private industry which will
allow it to implement change with minimal negative impact on its
employees, service officers and veterans.
It is important to understand that veteran service organizations
are both advocates for veterans and partners, or stakeholders, with VA.
In order for us to do our job effectively, we must have access to VA
computer systems, records, facilities and personnel. Without this
access, we might as well stand on the curb and shout at regional office
buildings.
Our relationship with Secretary Shinseki and VBA leaders has
steadily improved over the last four years. VA has shown progressively
greater transparency in many of the things it does. We have tried to
demonstrate to VA that while we are advocates for veterans and will
hold VA accountable for doing its many and varied jobs, we are also
willing to work with VA to help ensure that change, when it occurs, is
at least neutral in its effect on veterans. More importantly, we seek
to identify win-win opportunities: opportunities for improvement which
help both VA and veterans. A recent development within VBA illustrates
both the difficulties and benefits of working closely together to
achieve win-win situations.
Last summer VBA deployed elements of what has now become known as
the Simplified Notification Letter. In its earliest manifestation, VA
rolled back the clock to 1945 and began issuing rating decisions which
looked remarkably like those written at the end of WWII. Decisions did
not contain a discussion of the evidence considered or an explanation
of the reasons for the decision made - commonly referred to as
``reasons and bases.'' Decisions granting an evaluation did not contain
a summary of the rating criteria used to assign the evaluation nor an
explanation of what was needed to obtain the next higher evaluation.
These elements are required by VA regulations and court decisions. The
explanation for these changes was that it allowed raters to increase
production by 30-40 percent.
National service organizations were not consulted on these changes.
When we became aware of them, the VFW went to the VA regional office in
Atlanta to review both the ratings and notification letters to
veterans. We discussed our findings with project managers who made a
few changes to the program which provided additional, but very generic,
explanations to veterans.
These changes did not, in our view, meet regulatory and court
mandated requirements for explaining VA decisions to veterans. In order
for a veteran to understand a decision and determine whether it was
correct or not the law requires that he/she be provided certain
information. We believed this program failed to provide veterans with
the information required by law. We continued to press VA on this
program.
To their credit, VA made additional modifications and information
was added. Both the VFW and DAV continued to object to this program
because notice remained inadequate. It was only in the last few months
that we were all able to arrive at a point where the notice provided by
VA, when properly done, was adequate to satisfy our concerns, while
allowing VA to achieve increased production without further degradation
of quality.
We work with VBA at the national level almost daily. The VFW and
representatives from the largest veteran service organizations have
been meeting with VBA on a number of initiatives, including eBenefits
(working on ways to improve functionality and customer satisfaction for
veterans) and the Veterans Benefits Management System (VBMS) (to ensure
the needs of veterans representatives are addressed in VA's next
generation claims processing system).
We recognize and support VBA's plans on expanding customer and
service organization interaction with VA. VA has plans to allow
claimants and service officers to submit information and claims
electronically. VA indicates that it embraces the idea of permitting
veterans to change their contact information, such as an address or to
report changes in income (for pension) and add or subtract dependents
by computer. Any initiatives which allow claimants and their
representatives to submit data electronically or to effect minor
changes to awards based on user input, portends great savings in time
and money to VA, while offering enhanced service to veterans. The VFW
looks forward to continuing and improving our working relationship with
VA to find common sense solutions to reducing the claims backlog, while
improving rating decision outcomes.
Mr. Chairman, this concludes my testimony. I would be happy to
answer any questions that you or the members of the Committee may have.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, VFW has
not received any federal grants in Fiscal Year 2012, nor has it
received any federal grants in the two previous Fiscal Years.
Prepared Statement of Randall Fisher
Chairman Miller, Ranking Member Filner and distinguished Members of
the Committee:
Thank you for this opportunity to come before you today to discuss
the critical role of Veterans' Service Officers in the Department of
Veterans Affairs (VA) Disability Claims Process. Service Officers are
an often overlooked component of the claims process, yet we are the
front line soldiers in the battle for ensuring veterans receive the
benefits they deserve. On behalf of over 2,000 accredited service
officers of The American Legion, I am honored to be able to relate to
you the lessons learned through our struggles to get benefits for those
who have become disabled or have earned other benefits in their service
to this great nation.
This committee has dedicated a great amount of focus to how VA
operates in coping with a growing backlog of veterans' claims. As
service officers who daily see the massive scale of the challenges
facing VA, we are sympathetic to those men and women who work hard to
deliver these earned benefits to the veterans of America, and we
believe there are lessons VA could learn from our own experiences. In
part because of the dedication of this committee in giving voice to the
concerns of service organizations such as The American Legion, the VA
is now engaging in greater dialogue with the overall veterans'
community to solve our mutual challenges.
The problem is staggering. As of March 31, 2012 according to VA's
own figures, there are 897,556 claims currently pending for benefits.
Of that figure, more than 65 percent, a total of 589,483 of those
claims have been pending for over 125 days. For the past several years
VA has received over a million claims for benefits each year. In order
to tame this rising backlog we recognize we will all have to work
together.
The service officers of The American Legion believe there is a path
to success, and that path is dependent on being veteran-centric,
placing a high priority on training and understanding the operation of
the claims benefits system, and examining the work credit system to
ensure it helps foster an environment suited to getting the claims
processed properly the first time. We believe if VA makes a commitment
to adopting these principles in working with the veterans' community,
they will remain ahead of the fight in the battle to tame the backlog.
Veteran-Centric Approach:
American Legion service officers are made up almost entirely of
veterans. We understand the plight of veterans because we are veterans.
Perhaps the greatest role a service officer plays in the process a
veteran goes through in order to receive disability benefits is as a
translator. We are not only able to translate the military experience
of the veteran to VA employees, many of whom are not veterans
themselves, we are able to translate the bureaucratic language of the
VA back to veterans often confused by arcane complexities within the
legal process of the claims system.
As a veteran, you have instant understanding and recognition of the
language spoken by military veterans and utilized in military
documents. Whether we are understanding abbreviations used on a DD-214
discharge document or understanding the nature of noise exposure
suffered by a lance corporal assigned to an artillery unit, we know how
to read a veteran's file because the language of the military
subculture is our native language.
On a more personal level, when a veteran enters our office to speak
to us about their claim, they know they are talking to a brother or
sister service member. For lack of better terminology, we establish
trust with the veterans because they know we ``get'' them. The shared
sacrifice of shared service is a strong bond. For many veterans,
dealing with VA can be dealing with a faceless bureaucracy, no
different from interacting with the Department of Motor Vehicles.
Sitting down with a service officer to talk about your claim is sitting
down with a real person who has seen the same military you served in.
Trust goes a long way.
The American Legion has continually advocated for a greater role of
veterans within VA. This is helpful on many levels. As a trust issue,
it enables veterans to know they are dealing with someone who comes
from their background and is instantly perceptible as an ally in their
fight for benefits. From a technical perspective it is immeasurably
beneficial to be able to sight read military records, to know at a
glance what all the parts of a discharge examination should look like
and to be able to tell, not only what's present in a military file, but
what's missing. Finally, veterans have served their country once by
standing up and reciting the oath that inducted them into military
service. Working in the claims benefits system, whether for VA or for a
service organization such as The American Legion, gives them a
continued opportunity in their life to provide service to their country
and fellow service members. In the end it represents more jobs for
veterans of all ages and eras, critically important when veterans of
all ages are suffering from disproportionally high unemployment.
As service officers we also act as translators back to the veterans
when they receive contact from the VA. While VA is making strides in
contacting veterans to explain such notoriously complicated documents
like routine VCAA letters, the task of ``interpreting'' this language
often falls to the service officer. This is our job, to understand what
the VA is asking for, even if the legal dialect makes it less than
clear. Because, day in and day out, we must analyze claims before the
VA, we are sometimes the best person to read through that letter and
tell the veteran what is really missing with their claim.
This ultimately can save work for VA as well. With an unrepresented
veteran, the confusing nature of the letters often leads to veterans
submitting redundant or unnecessary information, adding further clutter
and confusion to the claims file. For example, in a case where VA
acknowledges a veteran's present condition of diabetes, but requires
further proof that the veteran was ``on the ground'' in Vietnam, it is
not uncommon for an unrepresented and uninformed veteran to become
confused and send VA more current medical information about the level
of disability presented by their diabetes, missing the crucial request
from VA for clarification on their service in Vietnam. A trained
service officer can better communicate that need to the veteran,
reassuring them that VA recognizes the extent the diabetes is affecting
their daily life, and directing the veteran's research to proving their
ship docked in the harbor which would grant the point of service
connection still under contention.
The process works both ways. We are not only impassioned advocates
on behalf of a veteran's claim; we are also facilitators for the VA in
delivering understanding to the veterans of the claims process and
where the work needs to be best directed. We accomplish this so
effectively because we speak the language of veterans. We accomplish
this because we are veterans.
Training:
Being a veterans' advocate is like being a doctor and lawyer all
rolled into one. This is a technical and sometimes confusing and
complicated business. The veterans' disability system is unlike any
other system of disability and requires specialized knowledge. You have
to understand how to read doctors' examination notes and how to piece
together fragments in incomplete military records. Moreover you have to
understand not only a convoluted section of the United States Code, but
also remain up-to-date on current precedential decisions being handed
down by the Court of Appeals for Veterans Claims (CAVC).
Maintaining a level of expertise in all of these areas and more
requires a dedication to training. The American Legion provides
national schools for its service officers twice a year, in Washington,
DC and in Indianapolis. These multiday schools are intensive and a
great resource. By coming together we not only get targeted training
based on evaluation of emerging concerns and changes, but we also
interact regularly with our fellow service officers to share best
practices and relate patterns we are witnessing in the VA system
overall. The training is not limited to those schools either; it is an
ongoing process, facilitated with regular updates and it has a high
priority in proportion to work.
Too often in speaking to VA employees we hear of training as an
afterthought, something that gets in the way of working. We are
encouraged to work in a culture that respects the training as a toll
essential to getting our work done, rather than an obstacle to getting
that work done. We hear VA employees at the Regional Offices dismiss
cases by the CAVC as ``something the Board [of Veterans Appeals] deals
with, not the RO'' when unfortunately that is far from the truth. If
Regional Offices better implemented the precedential decisions from the
CAVC at the local level, claims wouldn't have to go to the Board. They
could be settled right there at home for the veteran. We could cut a
lot of the backlog down with some better training for VA at the
Regional Office level.
Our training is often based on the common problems we see coming up
again and again in the claims process. We train on understanding VA
examinations because of the number of times we see exams come back
improperly, with the wrong forms filled out or the wrong conditions
examined. We train on areas of the rating schedule where there appear
to be inequities, such as mental health disorders where ratings can be
uneven and even seemingly random. We train how to understand what to
look for so we can best advocate and explain to VA why the veteran
deserves the rating we believe the evidence supports.
VA could learn from this and use this as a model to construct their
training. If an outside organization can base training off of common
errors and recent court decisions, VA should be able to manage a
training program that is targeted to common errors found in STAR
evaluations and in trends discovered through overturned appeals.
Especially as they convert to their electronic Veterans Benefits
Management System (VBMS) they should have even more tools to track
where training is needed and make it the priority it needs to be. VA
needs to examine the mindset service organizations have taken, which is
that taking the time necessary to train does not detract from the
ability to work, but rather enhances the ability to get the work done
right.
Work Credit System:
Much of the inherent culture at VA revolves around the number of
claims completed. Unfortunately it is somewhat lacking in the critical
accuracy component of getting the claim done right. We work in the same
Regional Offices as the VA employees. We hear their complaints all the
time too. Accuracy and training just don't merit the same consideration
as meeting the quotas and getting the right number of claims done each
week.
As service officers, we are sympathetic to the case loads. We have
to look at every case file for every veteran we see as well. The
difference is we know that if we miss something we're letting a fellow
veteran down. Yes, it might take a little bit longer to go over that
claims file and make sure everything is in order and we got the claim
done right. However, we also know if we got it done right, that claims
file is not coming back to our desk again. When you take the time to
get a claim right the first time, you are actually saving yourself work
down the road.
The VA employees deserve a tracking system for claims that will
reflect that mentality. We can see the numbers VA posts proudly on
their national website every Monday morning. Those numbers track the
number of claims they complete. VA needs to show their employees they
are just as committed to quality by making a system that tracks more
than just raw claims. There must be some way to factor in accuracy and
to account for the needed training.
Recommendations:
These categories represent a broad overview of the mentality and
work environment when a service officer tackles the task of
representing veterans for their deserved disability benefits. There are
a couple of simple lessons VA can learn from how we do business that
will hopefully help them achieve their stated goals of 98 percent
accuracy and no claim pending more than 125 days:
Hire more veterans. Veterans bring immeasurable useful
experience to the job and they present a face for a veteran accessing
the system that tells them this is someone who understands their
suffering and is there to help them.
Make training a priority. You can't do the job if you
don't know how to use the tools.
I VA training planners need to adopt the models used by VSOs and
develop training targeted to weaknesses and that is current to the
changes in law, regulation and decisions by the higher courts.
I Training also needs to have the same priority as the other
activities of work. Taking time away from working on a claim is okay if
you need that time to make sure you process that claim properly.
Reevaluate the Work Credit System.
I Accuracy needs to have the same priority as raw numbers.
I Training needs to be better integrated into the time
management system.
Summary
None of these challenges is insurmountable. We are all in this
together, whether we're a VA employee, a service officer or a veteran
seeking a benefit. We have to work together.
Service officers are passionate about our veterans because we see
them and speak to them on a daily basis. In many ways we are the public
face of the disability process for veterans, or at least the human
face. When you field a call from a veteran every week hoping for an
update on their claim, it can be heart rending, knowing how close to
the edge some of these veterans are, knowing how much a difference
resolving their claim can make for them. For a service officer, a
claims file can never become just a number in front of you because you
can always see the human face of who is being affected.
That is why it is important for us to express our experience from
years in the trenches. On behalf of the service officers accredited by
The American Legion and on behalf of The American Legion itself, I
thank you for taking the time today to listen to our testimony and
consider our input into the puzzle of solving the claims backlog.
Executive Summary
Service officers are the front line of defense in many ways for
veterans trying to navigate the disability claims system. They are the
human face who interacts on a daily basis with veterans to translate
the demands of VA to the veteran and to translate the military
experiences and sacrifices of the veteran to the VA. Due to this unique
position as go-between for veterans and VA, service officers have some
insight to offer in terms of improving VA's performance in dealing with
veterans' benefits.
Be more veteran-centric. Hire more veterans who can not
only easily speak and understand the language of veterans, but also
present a friendly and familiar veteran face to the community of
veterans seeking aid from VA.
Overhaul VA training.
I Ensure the training is targeted to common errors identified by
STAR and other methods.
I Ensure training reflects ongoing developments in the CAVC and
with law and regulation changes.
Reexamine the Work Credit System.
I Place Accuracy on a level with Raw Output.
I Make sure the work credit system accounts for training time
necessary to the schedule.
Prepared Statement of Paul Sullivan
The National Organization of Veterans' Advocates (NOVA) thanks
Chairman Jeff Miller and Ranking Member Bob Filner for the opportunity
to testify about the disability claim process at the Department of
Veterans Affairs (VA). NOVA is honored to share our views for this
hearing, ``From the Inside Out: A Look at Claims Representatives' Role
in the Disability Claims Process.''
NOVA is a not-for-profit 501(c)(6) educational membership
organization incorporated in the District of Columbia in 1993. NOVA
represents more than 500 attorneys and agents assisting tens of
thousands of our nation's military Veterans, their widows, and their
families obtain VA benefits. This statement was reviewed and approved
by NOVA's Board of Directors. I testify today as an employee of
Bergmann & Moore, LLC, a Bethesda, Maryland law firm representing
Veterans' whose disability claims were denied before VA and the U. S.
Court of Appeals for Veterans Claims (CAVC). Partners Glenn Bergmann
and Joe Moore are both NOVA members, and Joe Moore also serves on
NOVA's Board of Directors. Glenn Bergmann, Joe Moore, and I all
previously worked for VA.
NOVA members represent Veterans before all levels of VA's
disability claim process. This includes the Veterans Benefits
Administration (VBA), the Board of Veterans' Appeals (BVA, or
``Board''), the CAVC, and the U.S. Court of Appeals for the Federal
Circuit (Federal Circuit). In 2000, the CAVC recognized NOVA's work on
behalf of Veterans when the CAVC awarded the Hart T. Mankin
Distinguished Service Award to NOVA in 2000.
Our main goal for this hearing is to continue our strong working
relationship with Congress and VA so our Veterans receive timely and
accurate disability compensation claim decisions from VA. Receipt of
timely benefits remains vital for the Veteran's economic security as
well as opening the door to free VA medical care. NOVA believes the
``Veterans' Choice of Representation Act,'' part of the ``Veterans
Benefits, Health Care, and Information Technology Act of 2006'' (Public
Law 109-461) works as intended. The 2006 law eliminated the prohibition
on the charging of fees for services of an attorney or agent provided
before the Board of Veterans' Appeals makes its first final decision in
a Veteran's case.
NOVA's Training Seminars for Attorneys and Non-Attorney Agents
At NOVA, our primary purpose is providing quality training to
attorneys and non-attorney practitioners who represent Veterans,
surviving spouses, and dependents. NOVA offers four types of training.
Our primary type of training is our seminars held twice each year.
These events are attended by hundreds of attorneys and non-attorney
agents. Our seminars include presentations by leading practitioners and
experts about VA's disability claim process. Guest speakers at NOVA
training seminars often include academics as well as top VA and CAVC
leaders. Our seminars provide Continuing Legal Education (CLE) credits
for attorneys. NOVA membership requires completion of our seminars
every two years.
A second type of training is NOVA's ``Beginner's Guide to Veterans
Law.'' These DVDs are essential for those just beginning a Veteran
disability claim law practice. Last year, NOVA began offering our third
type of training feature, NOVA webinars, where attorneys and agents can
learn about Veteran law via the internet and receive CLE. And, finally,
NOVA members are able to access a heavily used private on line bulletin
board to ask questions of more experienced attorneys, share practice
tips, and keep updated on new case law and VA regulations.
NOVA Interaction with Veterans
When Veterans contact NOVA for assistance, NOVA's interaction
remains limited to providing referrals to our NOVA members listed on
our web site. Each of our NOVA members operates independently, so there
are different procedures regarding intake, screening, and acceptance of
cases. Because of their legal training, experience, and focus on
Veteran law, after a review of the Veterans' claim file, NOVA attorneys
know when Veterans' claims have merit.
As trained litigators, NOVA members assist Veterans by obtaining
vital military service records, military medical records, and
independent medical opinions regarding Veterans' medical conditions. In
cases where veterans have significant impairment, such as mental health
conditions and brain injury, these attorney-provided services are
essential in order to win the Veteran's claim. In many instances, NOVA
members' representation of Veterans results in significant changes in
the case law which improves the likelihood future veterans will receive
appropriate, prompt, and full disability compensation.
The Current System's Challenges
NOVA appreciates the significant, recent, and bi-partisan increases
in appropriations for VA as well as consistent Congressional oversight
of VA activities. While VA continues improving in many areas, several
other areas urgently need the attention of Congress. The area in most
need of immediate improvement is VA's overwhelmed and beleaguered
disability claim processing system.
The areas of greatest concern for NOVA are VBA's inability to
provide prompt and full access to records and VBA's unconscionably long
delays in claim processing. Our testimony provides several
recommendations to overcome these obstacles interfering with our
ability to properly represent Veterans.
VBA's delays are legendary and worsening. At the Regional Office
level, Veterans wait an average of more than seven months for a
decision. As of April 16, 2012, more than 903,000 Veterans' and
beneficiaries' claims languish at VBA. At the Board of Veterans'
Appeals, more than 256,000 disability claims remain mired, waiting an
average of an additional four more years for a decision. In total, VA's
disability claim backlog exceeds 1.1 million. In addition, more than
four thousand cases remain on the U.S. Court of Appeals for Veterans
Claims docket. When VA focuses attention on expediting new claims, VA
exacerbates the already bad situation by increasing the error rate,
leading to even more appeals and even longer delays. VBA appears to be
grinding to a halt.
Last Sunday, The New York Times reported the Oakland VA Regional
Office takes an unconscionable 313 days to process a new claim
(``Paperwork Buries Veterans' Disability Claims,'' Aaron Glantz, April
15, 2012). That's more than ten months. A few years ago, VA was
averaging five months. These significant VA delays seriously harm our
Veterans who need access to VA healthcare and who need disability
benefits to pay rent, put food on the table, and pay other important
expenses.
During testimony before the Senate Veterans' Affairs Committee on
February 29, 2012, VA Secretary Eric Shinseki stated VA has seen a 48
percent increase in claims filed since 2008. He expects the claim
volume to increase by another 4 percent in 2013 to 1.25 million claims.
This means an already bad situation continues deteriorating. This is
unacceptable for our Veterans.
In response to these disturbing statistics, and the significant
impact delays and errors have on our Veterans' health and economic
stability, VA sought out, and Congress wisely funded information
technology (IT) programs to handle the tidal wave of more than one
million claims flooding into VBA each year. NOVA applauds these moves
to bring VBA into the 21st Century.
First Set of NOVA Recommendations: Access to Information
NOVA urges Congress to enact legislation to improve and expedite
the access by attorneys and agents accredited by VA to information
about their Veteran clients. This is absolutely vital in order to
protect the Constitutional rights of our Veterans.
1. Access to Veterans' Electronic VA Records by Private
Practitioners
VBA's proposed e-Benefits system, also known as the Veterans
Benefits Management System (VBMS), does not contain a component
absolutely vital to our nation's Veterans and beneficiaries: full and
immediate access to Veteran's claim records by their attorney or agent.
This is the top complaint of NOVA members who work with Veterans every
day. The lack of access undermines our Veterans' due process rights and
property rights. See Cushman v. Shinseki, 576 F.3d 1290 (Fed. Cir.
2009) (ruling that applicants for VBA benefits have a constitutionally
protected property interest in their entitlement to those benefits).
NOVA urges Congress to mandate that VA promptly provide advocates
full access to paper and electronic claim records. What NOVA seeks is a
``read only'' secure access to Veterans' records via the internet. Such
a system is already in place at the Social Security Administration
(SSA). SSA uses the ``Appointed Representative Suite of Services''
(ARSS) computer system. Information about legal representation is
promptly entered into a beneficiary's records, and attorneys are
provided with full and immediate access to SSA records on-line. SSA's
ARSS system should serve as a model for VA to adopt in its new IT
system that also preserves and protects Veterans' rights. In simple
terms, if ARSS meets the standards for Health Insurance Portability and
Accountability Act of 1996 (HIPAA; Public Law 104-191, 1996), then
Congress should mandate a similar system for VA.
2. Improving Access to VBA Points of Contact for Private
Practitioners
Under current VA rules (M21-1MR, Part I, Chapter 3, Section C, 14,
``General Information on Fees''), VA's Attorney Fee Coordinators (AFC)
at VBA Regional Offices serve as liaisons with attorneys and agents,
many of whom are NOVA members. In most cases, AFCs are cooperative and
helpful to NOVA members, providing prompt and accurate status updates
on Veterans' claims. This is important because NOVA members
representing Veterans are not co-located inside the VA Regional Office
and do not have physical access to VBA staff, VBA computer systems, or
VBA paper records. Our contact is limited to e-mails, FAX, and
telephone, which is severely restricted by VA. Private practitioners
currently have no assured access to VA claims processers, and long
delays often result in cases where VA communicates with veteran
advocates only via the U.S. Postal Service.
However, there are harmful exceptions, where some AFCs are directed
by their supervisors to refuse to provide attorneys and agents with
critical information. The lack of accurate and timely information about
the status of a Veteran's case significantly interferes with the
ability of NOVA members to properly represent their clients. In many
instances, AFCs provided inaccurate information or referred NOVA
members to VBA's 1-800 phone number. NOVA understands AFCs often have
several other job functions and lack the time and training to properly
and promptly assist attorneys and agents. However, when an AFC does not
provide information or provides incorrect or incomplete information,
VA's actions further delay veterans' claims.
NOVA urges Congress and VA to make it clear, through law or
regulation, that AFCs are to assist accredited attorneys and agents by
providing accurate and prompt status information on Veterans' claims.
We believe the duties of AFCs should be limited to the role of
assisting accredited attorneys and agents in all but the smallest
Regional Offices.
3. Entering Information Sent to VA in a Correct and Timely
Manner
Most large Veteran Service Organizations (VSO) staff are co-located
inside VA Regional Offices. They often hand-deliver critical and time
sensitive documents such as notices of disagreement and substantive
appeals, and thus are able to ensure VA's databases are correctly
updated and documents are associated with the Veterans' paper claims
folder.
In contrast, NOVA members are not co-located at VA Regional
Offices. Therefore, NOVA members usually fax or mail POA and NOD forms
to VA Regional Offices.
Unfortunately, it is the widespread experience of NOVA members
that, depending on the individual Regional Office, documents need to be
resent because VA lost them - or did not update the system correctly
when they were received so no one knows they are in the claims folder -
anywhere from 25 to 75 percent of the time. This is especially critical
since the mishandling of timely documents such as an appeal can
potentially cause further delay of a Veteran's case.
NOVA urges Congress to mandate that VA upgrade the training
provided to mailroom employees, including offering incentives
encouraging VA's mailroom staff to complete their jobs correctly the
first time.
4. Decreasing Blocked Calls and Incorrect Information Given by
VA
Calling VA's Toll-Free ``Inquiry Routing and Information System''
(IRIS), 800-827-1000, too often results in incomplete or incorrect
information. As described above, many AFCs refer attorneys and agents
to IRIS. The results are dismal, and in need of urgent correction.
According to VA's Office of the Inspector General (OIG):
In [Fiscal Year] 2009, individuals reached an agent 76 percent
of the time. Of those reaching an agent, agents answered 72 percent of
their questions correctly. When we combined VBA's reported data on
access and accuracy, we concluded that any one call placed by a unique
caller had a 49 percent chance of reaching an agent and getting the
correct information.
Even worse, VA employees appear hesitant to answer indirect
questions, defined by OIG as questions ``that are not asked directly
but are relevant to providing a complete answer'' (emphasis added). In
those cases, VA staff only answered 60 percent of indirect questions
accurately. This issue remains a chronic challenge for VA. For eight
years, Veterans and their advocates remain unable to obtain correct
answers from VA.
Knight Ridder Newspapers reported on an internal VA report from
2004 (``VA Help Lines Found to Regularly Provide Wrong Information,''
Chris Adams, December 30, 2005):
According to an internal VA memo on the mystery-caller program
that's buried deep in the department's Web site, 22 percent of the
answers the callers got were ``completely incorrect,'' 23 percent were
``minimally correct'' and 20 percent were ``partially correct.''
Nineteen percent of the answers were ``completely correct,'' and 16
percent were ``mostly correct.''
Veterans, attorneys, and agents deserve correct and complete
answers. NOVA recommends that VA improve training and oversight with
two goals in mind. First, VA needs to end the 24 percent of calls from
Veterans to VA that are blocked. VA needs to increase the accuracy of
both direct and indirect answers provided to veterans to well above 90
percent.
Second Set of NOVA Recommendations: End Delays in Adjudicating Appeals
In order to please Congress, VA has previously placed an emphasis
on adjudicating original claims as quickly as possible. Although we
applaud Congressional attention to this matter and the noticeable
results in claim processing, these numbers have come at a steep cost.
That cost is in the area of Veterans' appeals. Just to give an example
of the chronic understaffing in this area, our firm heard from multiple
Regional Offices that its appeals consist of more than 3,000 cases and
are growing by the day. However, the ROs have only two or three
Decision Review Officers (DRO) working on appeals. At those offices, we
were told the wait for a Statement of the Case (SOC) to be issued
following the submission of a Notice of Disagreement is ``at least 1100
days.''
Although a wait of more than three years is, by itself,
inexcusable, what makes this wait worse is that Veterans' claims do not
even get in line for a BVA decision until an SOC has been issued and
the Veteran has filed a Substantive Appeal. BVA is currently working on
cases with 2010 docket numbers. In practical terms, this means a
Veteran who already waited three years for VA to issue a SOC, who then
submits a Substantive Appeal, must wait an additional two years before
BVA reviews the case.
The final insult in all of this is that BVA is forced to remand
many cases back to Regional Offices. (If the Veteran is not represented
by a private practitioner, the Veteran's case is sent to the Appeals
Management Center.) In theory, a Regional Office is supposed to provide
``expedited'' treatment to the Veteran's case. However, in practice,
the Veteran's claim goes to the back of the line and waits once again
with the rest of the appeals. Chronic VA delay in processing Veterans'
appeals harms our Veterans by denying them access to medical care and
economic security. NOVA supports VBA's goals and intents of hiring more
DROs, as they remain the most efficient way to fix the multiple errors
found in the majority of rating decision issues.
NOVA supports hiring more DROs to meet the increasing number of
appeals handled at VA's Regional Offices. DROs should also be used for
their intended purpose. However, DROs were recently tasked with
handling hundreds of thousands of Vietnam War Veterans' disability
claims for medical conditions associated with exposure to Agent Orange
(Nehmer v. U.S. Department of Veterans Affairs, No. CV-86-6160). We
understand nearly all Nehmer cases are resolved, and this should allow
DROs to return to their original function. Unfortunately, most DROs are
returning to enormous backlogs and heightened pressure to adjudicate
cases quickly, without regard to accuracy.
Conclusion
NOVA supports funding for VA initiatives to computerize VA's
obsolete claims processing systems. NOVA believes our reasonable and
practical recommendations to VA's initiatives, especially greater and
faster access to Veterans' records and an end to VA's systemic delays,
will result in our Veterans receiving more timely and accurate
decisions from VA. NOVA offers to work with the Committee and VA to
implement our recommendations.
Prepared Statement of Thomas J. Murphy
Mr. Chairman and Members of the Committee, thank you for the
opportunity to testify today on the important partnership between the
Department of Veterans Affairs (VA) and the various national, state,
and county Veterans Service Organizations (VSOs).
As VA moves into the 21st Century, this collaboration establishes
the foundation for providing Veterans with the benefits they have
earned in a timely and equitable manner. This partnership focuses on
assisting Veterans with filing disability claims and receiving
appropriate compensation for service-connected diseases and injuries.
Trained claims representatives from VA-recognized VSOs provide
invaluable guidance to Veterans filing claims and work with employees
of the Veterans Benefits Administration (VBA) to ensure that complete
and accurate information is available to facilitate correct disability
and compensation decisions. Office space is provided for these claims
representatives in all VA regional office service centers, where they
assist with evidence development, view decisions made by VBA employees
, and counsel Veterans regarding claims and appeals.
Training
To further the collaborative effort with VSO claims
representatives, VBA established a training program and certification
process for them. In 2008, the Training, Responsibility, Involvement,
and Preparation of Claims (TRIP) program was introduced. The TRIP
program was designed to improve overall service to Veterans, as well as
improve claims processing timeliness, by instructing the
representatives on the requirements for successful claim processing and
familiarizing them with VBA computer systems. This web-based course
offers multiple video lesson presentations followed by review
questions. The course helps participants learn the information needed
to pass a multiple-choice final examination. Participants have 45 days
from the starting date to complete the course, which is accessible at
any time. Successful completion of the program allows claims
representatives to be certified and have read-only access to a number
of claim processing-related electronic applications that follow the
development and adjudication of Veterans' claims. To date, over 4,100
service organization representatives have registered for the online
course, and since 2008, 3,385 representatives have completed the course
by passing the final exam. TRIP training is a critical part of VBA's
goals to improve access and transparency to the disability claims
process and thereby improve efficiency.
In addition, under VA's accreditation regulations, VSOs are
required to certify every five years that each of their accredited
claims representatives continues to be of good character and reputation
and has demonstrated an ability to represent claimants before VA. The
VSOs must also certify that each accredited representative is either a
member in good standing or a paid employee; is accredited and
functioning as a representative of another recognized VSO; or, in the
case of a county Veteran's service officer, is a paid county employee,
has successfully completed an approved course of training and an
examination, and will receive regular supervision or annual training to
ensure continued qualification as a representative in the claim
process.
Transformation
As the Committee is aware, VBA has developed and is now
implementing its Transformation Plan, a series of tightly integrated
people, process, and technology initiatives designed to improve
Veterans' access, eliminate the claims backlog, and achieve our goal of
processing all claims within 125 days with 98 percent accuracy in 2015.
We are confident that we are on the right path to deliver more timely
and accurate benefits decisions to our Nation's Veterans. VSO
involvement in our Transformation Plan is extremely important,
especially as we shift from a paper-based to a paperless electronic
process system. VBA is committed to providing service organization
representatives with the tools to assist with this transformation.
VBA is developing an electronic Stakeholder Enterprise Portal
(SEP). This portal will enhance stakeholder involvement in the claims
process in a secure environment with identity access tools. VSOs will
be able to access SEP, which will facilitate the ability to assist
Veterans with online completion of VA form 21-22, Appointment of
Veterans Service Organization as Claimant's Representative and the
Veteran's online application for compensation, known as VONAPP Direct
Connect (VDC).
Additionally, VBA is working with service organization
representatives to implement the fully developed claims (FDC)
initiative. The Veterans' Benefits Improvement Act of 2008, Public Law
110-389, section 221(a), directed VA to carry out a one-year pilot
program to assess the feasibility and advisability of expeditiously
processing fully developed compensation and pension claims within 90
days after receipt of the claim. Based on the favorable results from
the pilot, VA expanded and fully implemented the program across all
regional offices under existing authority of 38 U.S.C. Sec. 501(a)(4),
which provides the Secretary's authority to prescribe rules and
regulations to include establishing the manner in which claims are
adjudicated. Claims representatives are critical to the FDC initiative
as they assist in gathering supporting evidence for a disability claim
and helping the Veteran to certify that no additional evidence is
necessary to make a decision on the claim.
Service organization representatives are an integral part of VBA's
Transformation Plan because of their close personal contact with
Veterans. VBA constantly seeks to improve the claims process, and
service organization representatives serve an important role in that
effort.
This concludes my testimony, and I look forward to answering your
questions.
Materials Submitted For The Record
PARALYZED VETERANS OF AMERICA
Chairman Miller, Ranking Member Filner, and members of the
Committee, Paralyzed Veterans of America (PVA) is pleased to present
information regarding how PVA claims representatives work to assist our
nation's veterans to obtain the benefits that they have earned and
deserve for their sacrifices for America. PVA takes great pride in the
competence, professionalism and dedication of these individuals who
spend countless hours training and working to ensure they can
accurately represent a veteran and his or her family.
Since 1971, PVA's National Service Program has distinguished itself
by readying service officers for the more complex aspects of VA claims
work. This includes an in-depth understanding of Special Monthly
Compensation, which often entails assessment of co-existing
disabilities and overlapping conditions against the VA combined rating
table in order to arrive at an accurate disability rating.
PVA's intensive training program indoctrinates every service
officer into the organization with a comprehensive lesson on the
history, evolution, and current state of the VA spinal cord injury
system of care. The more traditional aspects of our National Service
Officer (NSO) Candidate Training curriculum begin with teaching the
fundamentals of VA claims adjudication: eligibility and application for
compensation, pension, education, insurance, survivor, burial, and
ancillary benefits. The program then covers health care benefits and
eligibility, including clinical appeals, beneficiary travel, and
prosthetics equipment. At present, to even better improve the quality
and competence of our NSOs, the program is undergoing a transition from
an 18-month distance-learning curriculum to a paperless 12-month on-
line platform that offers instant feedback and real-time content
updates, which ensure the student is being tested on the most current
and relevant information possible in an ever-transforming VA
environment.
During the process, all candidates are mentored by an office
supervisor, Area Manager, or Region Director, and given on-the-job
training objectives that demonstrate readiness for the next phase of
learning. Forthcoming training initiatives include the addition of a
capstone module where NSO Candidates must demonstrate proficiency in
case review and oral/written presentation, based on real case studies,
before graduating from the program and working independently.
Additionally, we have added a requirement that all candidates who are
being considered for promotion to the rank of Senior National Service
Officer must successfully complete a one-week residency at the PVA
National Appeals Office. The main goal of PVA's in-depth training and
evaluation process is to ensure the greatest accuracy of claims
processing, a function critical to the reduction of the significant
claims backlog currently facing VA.
While the initial training and requirements build a strong
foundation for a successful process, to maintain their expertise, all
field staff, regardless of rank, must undergo continuing education in
order to remain accredited. One technique that satisfies this
requirement is PVA's annual Continuing Education Seminar. During this
training event, PVA instructs NSOs in legislation/regulatory changes,
provides refresher training, and hear from VA leadership who are
invited to speak directly to PVA NSOs. PVA also conducts quarterly
regional training via teleconference. These programs ensure NSOs have
the most up-to-date information and benefit tremendously from the
interaction between the NSOs who share their own stories of successes
and challenges they have faced.
The PVA program's emphasis on spinal cord injury and its effects,
which can prove esoteric even to some in the health care profession,
conditions PVA NSOs to confront the complexities involved in resolving
the ambiguities and uncertainties that typify catastrophic disability
claims. For this reason, our sister Veteran Service Organizations have
been known to defer to PVA for cases presenting complex disability
pictures, where Special Monthly Compensation and entitlement to
ancillary benefits (e.g. Specially Adapted Housing, Adaptive Auto
Equipment, annual clothing allowance, etc.) are at issue.
This time-tested approach to training has created an excellence-
driven culture within PVA's Veterans Benefits Department: one that
prides itself on unrivaled quality in the development of disability
claims. Senior Benefits Advocates and hospital-based National Service
Officers receive an intense, week-long indoctrination into medical
monitoring and health care advocacy during AMAT (Advance Medical
Advocacy Training) in addition to the initial NSO Candidate Program and
annual Continuing Education Program attended by all accredited
representatives.
To date, our National Service Program has secured over $1.5 billion
in annual and retroactive awards for clients. This fiscal year alone,
our field staff has filed over 14,000 issues and attained over $135
million in awards thus far. Also, our staff has claimed over 580
victories on behalf of clients resulting in significant retroactive
awards totaling $25,000 or more this year. Finally, our Appeals Office
currently outpaces the Board average allowance rate by nearly 5
percent, and has seen fewer denials by a rate of nearly 7 percent.
In sum, we do not view these successes as the product of mere good
fortune or solid reputation. We achieve results by planting the seeds
of higher expectation in our candidates early and reinforcing that
standard at every stage of the service officer's development.
PVA appreciates the interest and effort that has been given to
updating and modernizing the VA disability system in recent years.
However, it is important to note that success in reforming the VA
claims processing system will require the VBA to institutionalize the
ongoing transformation process at all levels to develop a work culture
that values, measures, reports and rewards quality and accuracy over
speed and production. This has been the approach used by PVA in
training NSOs.
The VBA is entering its third year of its most recent effort to
transform an outdated, inefficient, and inadequate claims-processing
system into a modern, automated, rules-based and paperless system. VBA
has struggled for decades to provide timely and accurate decisions on
claims for veterans' benefits, especially disability compensation.
However, despite repeated prior attempts to reform the system, VBA has
never been able to reach the goals it has set for itself. Whether VBA
can be successful this time depends to a large extent on whether it can
complete a cultural shift away from focusing on speed and production to
a business culture of quality and accuracy.
There have been some encouraging steps towards such a cultural
shift over the past two years; however, this early progress must be
institutionalized in order to create the long term stability needed to
eliminate the current backlog of claims, and more importantly, prevent
such a backlog from returning in the future. VBA must change the way it
measures and reports the work it performs as well as the way in which
employees are rewarded, in order to reflect the principle that quality
and accuracy are at least as important as speed and production.
Ensuring that decisions are correct the first time will, over time,
increase public confidence in the VA and decrease appeals.
One of the more positive steps that has occurred as a part of VBA's
transformation has been the open and candid attitude of VBA's
leadership over the past several years, particularly progress towards
developing a new partnership between VBA and VSOs who assist veterans
in filing claims. PVA applauds these efforts and this hearing is an
example of greater encouragement of these efforts. VSOs have vast
experience and expertise in claims processing, with local and national
service officers holding power of attorney for hundreds of thousands of
veterans and their families. As indicated by PVA's testimony, VSOs can
make VBA's job easier by helping veterans prepare and submit better
claims, thereby requiring less time and resources to develop and
adjudicate them. Veterans Service Organizations have been increasingly
consulted on a number of the new initiatives underway at VBA, including
Disability Benefit Questionnaires (DBQs), Veterans Benefit Management
System (VBMS), and many, but not all business process pilots, including
the I-LAB at the Indianapolis VARO. Building upon these efforts, VBA
must continue to reach out to its VSO partners, not just at central
office, but also at each of the 57 Regional Offices.
Ultimately, PVA remains hopeful that the VA may finally be making
real progress towards meaningful reform to the claims process that will
ensure veterans receive accurate decisions the first time. VA must be
more consistent in the application of its own regulations and it is up
to VA's senior leaders in the field to ensure training standards are
enforced and to eliminate variability in the claims adjudication
process to the greatest extent possible. A rater in San Diego should
not have a different standard for assessing ``loss of use'' than a
rater in Boston and conflicting medical opinions should not
disproportionately warrant denial of a claim, particularly when
reasonable doubt provisions compel the rater to find in favor of the
claimant. Predictability in the process is the key to fixing this. It
will be incumbent upon the Committee to conduct substantive oversight
on VBA's activities to ensure that the primary objective--accurate
decisions the first time--is being achieved.
PVA appreciates the opportunity to outline the process PVA uses to
ensure our veterans seeking claims with VA present the most accurate
information the first time. We cannot emphasize enough that the close
integration and cooperation between VA and VSO veterans'
representatives is critical to providing the best services for our
veterans. PVA looks forward to working with the Committee to ensure
that veterans receive the best possible determination for benefits in
the most efficient manner possible. Thank you.
Information Required by Rule XI 2(g)(4) of the House of Representatives
Pursuant to Rule XI 2(g)(4) of the House of Representatives, the
following information is provided regarding federal grants and
contracts.
Fiscal Year 2012
No federal grants or contracts received.
Fiscal Year 2011
Court of Appeals for Veterans Claims, administered by the Legal
Services Corporation--National Veterans Legal Services Program--
$262,787.
Fiscal Year 2010
Court of Appeals for Veterans Claims, administered by the Legal
Services Corporation--National Veterans Legal Services Program--
$287,992.