[Senate Hearing 113-168]
[From the U.S. Government Publishing Office]
S. Hrg. 113-168
VA CLAIMS SYSTEM: REVIEW OF VA'S TRANSFORMATION PROGRESS
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
DECEMBER 11, 2013
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
Bernard Sanders, (I) Vermont, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Johnny Isakson, Georgia
Sherrod Brown, Ohio Mike Johanns, Nebraska
Jon Tester, Montana Jerry Moran, Kansas
Mark Begich, Alaska John Boozman, Arkansas
Richard Blumenthal, Connecticut Dean Heller, Nevada
Mazie Hirono, Hawaii
Steve Robertson, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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December 11, 2013
SENATORS
Page
Sanders, Hon. Bernard, Chairman, U.S. Senator from Vermont....... 1
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 5
Murray, Hon. Patty, Chairman, U.S. Senator from Washington....... 6
Heller, Hon. Dean, U.S. Senator from Nevada...................... 7
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 8
Boozman, Hon. John, U.S. Senator from Arkansas................... 8
Begich, Hon. Mark, U.S. Senator from Alaska...................... 9
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 10
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 26
WITNESSES
Hickey, Hon. Allison A., Under Secretary for Benefits, U.S.
Department of Veterans Affairs; accompanied by Diana M. Rubens,
Associate Deputy Under Secretary for Field Operations, Veterans
Benefits Administration; Brad Houston, Director, Office of
Business Process Integration, Veterans Benefits Administration;
and Richard Hipolit, Assistant General Counsel, Office of
General Counsel................................................ 11
Prepared statement........................................... 14
Response to prehearing questions submitted by Hon. Richard
Burr....................................................... 20
Response to posthearing questions submitted by Hon. Bernard
Sanders.................................................... 23
Response to request arising during the hearing by Hon.
Richard Burr 28,29
APPENDIX
Paralyzed Veterans of America; prepared statement................ 43
VA CLAIMS SYSTEM: REVIEW OF VA'S TRANSFORMATION PROGRESS
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WEDNESDAY, DECEMBER 11, 2013
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:03 a.m., in
room 418, Russell Senate Office Building, Hon. Bernard Sanders,
Chairman of the Committee, presiding.
Present: Senators Sanders, Murray, Brown, Begich,
Blumenthal, Burr, Isakson, Boozman, and Heller.
OPENING STATEMENT OF HON. BERNARD SANDERS,
CHAIRMAN, U.S. SENATOR FROM VERMONT
Chairman Sanders. Good morning. Thanks, everybody, for
coming to what I believe will be a very informative and
important hearing on an issue that is of concern to veterans
all over this country and to every Member of this Committee.
Today, we are going to continue our oversight of VA's
efforts to transform the claims system. As members will recall,
earlier this year this Committee met to discuss one of the
major challenges confronting VA, the claims backlog.
I think all of us have heard from veterans who are deeply
concerned about the backlog. It is a concern to the Veterans
Service Organizations, I know it is a concern to every Member
of this Committee, and I suspect every member of the Senate.
The origin of this problem goes back a number of years. It
has everything, in my view, to do with the reality that, until
2008--and maybe at some point General Hickey can give me some
clues about this--for whatever reason, there was no serious
effort on the part of VA to do what every other major
corporation and government agency in this country had done, and
that is, move from the world of paper to electronics.
I do not quite understand, given the enormous amount of
paper facing VA historically, why it took so long for them to
do that. Nonetheless, that was the case.
Furthermore, VA has also had to deal with a staggering
number of new claims, tragically, for veterans who served in
Afghanistan and Iraq. On top of that, VA--I think
appropriately--made sure that veterans who were impacted by
Agent Orange in Vietnam also got the benefits to which they
were determined to be eligible for. So, that is a lot of stuff
coming in.
Nonetheless, this Committee, at our hearing in mid-March,
despite all of these factors, heard about the unacceptably
large number of claims that were pending and the numerous
challenges confronting VA. It is my view, and I believe it is
the view of every Member of this Committee, that no veteran in
our country should have to wait years to have his or her claim
adjudicated. It is a disgrace and that is an issue that must be
dealt with.
Today, as I understand it, VA is going to give us some good
news, welcome news, about significant progress made in this
area. When we last met in March to discuss this issue, there
were over 896,000 claims in the inventory. Of that number, more
than 632,000 or 70 percent were backlogged or pending longer
than VA's goal of 125 days. That is a staggering number.
Today, as I understand it, those numbers look much
different and, in fact, are much improved. The number of claims
pending longer than 125 days, or officially part of the
backlog, has dropped to just over 395,000 claims or 57 percent
of the total inventory. That is still a large number but is a
significant improvement. The total number of pending claims has
dropped to its lowest level since July 2012 at slightly less
than 694,000 claims.
Let me be clear--and I think we can all agree on this--many
challenges remain. This Committee will touch on some of those
challenges and I will deal with them in my statement this
morning.
We must, however, begin today by acknowledging the progress
we have seen since we last met in March. I want to thank
General Hickey and her staff and maybe most importantly, the
hundreds and thousands of hard-working folks at VA all over
this country who have put their shoulder to the wheel to see
the improvements that we are going to be talking about today.
So, I want to thank VA for those improvements.
For the fourth year in a row, VA has processed more than
one million claims. This is no small feat given the sheer size
of the transformation the Department is undertaking.
VA is moving to an electronic claims processing system and
VBMS, which is a major component of that system, has been
deployed to every regional office, as I understand it, ahead of
schedule.
The Department has implemented a new organizational model
changing the way in which it processes claims, and it continues
to build upon efforts to improve employee training and address
underperforming regional offices. I believe this Committee has
worked in a productive and bi-partisan manner to support VA's
efforts while also holding it accountable for meeting its
ambitious claims processing goals. I have said this before and
I say it again.
I applaud General Shinseki, Secretary of VA, for having the
courage to do what I think very few public officials do. He put
in black and white a goal, so there is no ambiguity attached to
it. He said that he wants to see all claims processed within
125 days at 98 percent accuracy by 2015.
So, he has put VA out on a line on this issue, and we will
be talking with General Hickey and the others today to see, in
fact, whether they are on schedule to achieve that goal. That
is very clearly an extremely ambitious goal.
Following the March hearing, I was joined by all of my
colleagues on this Committee in asking for DOD's, the
Department of Defense's, continued commitment to help VA
eliminate the backlog. That is a huge issue, and we have got to
move forward on this.
This Committee continues to closely monitor, and when
necessary, encourage greater cooperation between the
Departments because at the end of the day this problem is not
going to be solved until there is greater cooperation.
Members from both sides of the aisle have presented
legislative ideas to address these problems. I am confident a
number of these ideas, including significant portions of the
Claims Processing Improvement Act that I introduced earlier
this year, will pass the Senate this week as part of a
veteran's omnibus bill. So, we are making some legislative
progress in this area.
This Committee also continues to conduct aggressive
oversight of VA's transformation efforts, in part through
hearings like this one, in order to hold VA accountable for
meeting its ambitious claims processing goals.
Despite the very good progress that I think we are going to
hear about today, we all know--I do not think there is any
debate on this--that VA is not yet where it needs to be in
addressing the very serious problem of the backlog issue.
Veterans are still waiting too long for a decision and the
Inspector General continues to find issues with the quality of
the work.
I am concerned by the most recent IG findings, which found
significant problems with provisional rating decisions reviewed
at the Los Angeles Regional Office, and this is an issue we
will want to discuss this morning.
During Committee oversight, my staff has identified clear
and unmistakable errors in provisional rating decisions. I am
pleased to hear VA is taking action to remedy the problems
identified by the IG.
However, this should have been done immediately upon
recognition of the problem at the local level; and here I think
is the important point that I want to make.
Reducing the backlog at the expense of accuracy is not
acceptable. Our goal is to move forward rapidly to make sure
that this backlog goes down but we will not do it at the
expense of accuracy.
This Committee will continue to examine the oldest claims
first initiative and the issuance of provisional rating
decisions. This is an enormously important issue.
The Committee's oversight efforts will also continue to
focus on other components of transformation to ensure VA is
providing timely and accurate decisions.
For example, VA still has a long way to go in creating a
truly electronic claims processing system, a system that does
not rely on the scanning of millions of pieces of paper.
VA must also ensure that, as it transitions to a Web-based
system, it does not inadvertently disadvantage certain
populations of claimants, such as elderly veterans or those
veterans living in rural areas, with limited internet access. A
very important issue in States like Vermont.
Finally, VA must do more to address other work pending at
the ROs, regional offices, such as appeals and award
adjustments. Despite the significant reduction in claims
measured as part of the backlog, other pending work has
continued to climb since our last hearing on this issue.
Finally, let me touch on a few areas that I believe VA
needs to focus on in its efforts to transform the claims
system. VA must focus on the appellate process. This is a large
part of the claims system, and it is not receiving, in my view,
the attention that it deserves.
General Hickey, I know VA has been piloting a number of
ideas in the Houston Regional Office, but I think we need some
increased leadership attention on these efforts in order to
ensure real progress is being made on appeals.
In that regard, the numbers are not good. According to VA's
Performance and Accountability Report, last year it took on
average 866 days, as I understand it, to provide a final
decision on an appeal.
Let me repeat that. Veterans were waiting on average 866
days for a final decision on an appeal. This is why providing
an accurate initial decision, by the way, is so important, so
we do not have to go through the appeals process.
General Hickey, I am requesting of you today to get back to
us as soon as you possibly can, certainly if you can by the end
of January, with how you plan to improve the processing of the
appellate workload at the ROs.
In 2009, VA began an effort to revise and update VA's
rating schedule which is an enormously complicated process, and
I know and I think we are all aware that this is painstaking
work, but I am concerned about the progress of this effort.
In the fall of 2012, the GAO provided a comprehensive
review of this effort and the associated challenges. The rating
schedule is the foundation of the claims system and any future
updates will impact every piece of transformation from the
rules based calculators to employee training. VA will need to
spend significant time and energy reprogramming computers,
modifying forms and ensuring employees are properly trained on
the updated schedule.
As VA moves forward with this update, it must plan
accordingly. Too often in the past, the Department was not
prepared to cope with major changes to the claims system and
that failure resulted in negative experiences for veterans. Let
us not see history repeat itself in that area.
Finally, VA needs to continue to demonstrate with data and
hard facts how transformation will ultimately improve the
veteran experience and result in more timely and accurate
decisions.
In closing, let me say this. I am pleased by the fact that
VA has taken very seriously the claims backlog. General Hickey
and her staff are working very, very hard to address this
problem. It is very clear that significant progress has been
made, and we appreciate that very much. But it is also clear
that a whole lot of important work remains to be done.
So, we appreciative that General Hickey is with us today.
We are going to begin speaking with her in a moment.
First, Senator Burr is not yet here and Senator Isakson
will be acting as ranking member.
Senator Isakson.
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. Thank you, Mr. Chairman. I would like to
welcome the members of VA for sharing their testimony today. We
appreciate them coming.
As we will hear today, VA has taken a number of steps to
try to improve its handling of disability claims and, in recent
months, the backlog has started to decline. Although any true
progress is welcome, I think there are still many reasons for
concern.
To start with, nearly 700,000 veterans and their families
do not yet have an answer to their requests for benefits, and
they can expect to wait at least 9 months for a decision. Also,
we continue to hear from veterans' groups about how often VA
makes mistakes in the processing disability claims.
In fact, The American Legion recently testified that it
found errors in over half of the decisions that it reviewed
last year. This is of real concern to me and to every Member of
the Committee because it can take years for a veteran to
correct those errors through VA's appeal process.
Today, more than a quarter of a million appeals are waiting
to be resolved. This number has been trending upward, not
downward. The work has also been piling up, such as claims, for
accrued benefits, responses to incoming mail, and adjustments
to monthly checks based on how many dependents a veteran is
claiming.
The number of dependency adjustments waiting for VA
decision has tripled in just over 2 years, and what VA calls
the ``correspondence'' has grown nearly five times since last
year.
All of this raises questions about VA and its
prioritization work that is not counting the backlog statistic.
Mr. Chairman, I want to follow up on your comments with
regard to provision problems that we have seen. As you know,
the Committee asked the Inspector General to review the
provisional initiative to make sure claimants would receive
appropriate, quality decisions without any unnecessary hurdles.
Although that review is not finished, the Inspector General
testified last week that it found 10 errors out of 11
provisional decisions at one regional office.
In fact, it appears that the employees were encouraged to
violate VA policy by making provisional decisions without first
obtaining necessary medical examinations. That office has now
reviewed all of its provisional decisions and found hundreds
that contained errors.
Mr. Chairman, all of this suggests that more must be done
to make sure VA's efforts to reduce the backlog will not cause
veterans and their families more delays or more frustrations
down the road.
VA must be held accountable for making real, lasting
improvements in the services provided to those seeking benefits
from VA which they have earned. I look forward to working with
you and the rest of the Committee to ensure that happens.
I thank the Chairman.
Chairman Sanders. Thank you, Senator Isakson.
Senator Murray.
STATEMENT OF HON. PATTY MURRAY,
U.S. SENATOR FROM WASHINGTON
Senator Murray. Thank you very much, Mr. Chairman. I really
do appreciate your holding this hearing.
Ending this claims backlog and building a timely, accurate
claims processing system is one of the absolute top priorities
for our veterans. I continue to hear frequently from veterans
in my homestate of Washington that they are still waiting far
too long for their claims to be completed. I know that getting
this right is a top priority for the Department and I
understand this is a very complex problem that has no single,
easy solution.
So, I am encouraged by the steps VA has taken so far, but
we have a very long way to go.
VA's initiative to expedite the oldest claims was a good
step. However, I have heard repeatedly from veterans that they
were confused and frustrated with the provisional rating
process. Some believe their claims have been flat out rejected
and others did not understand that they had a year to submit
additional evidence.
Under Secretary Hickey, we need to hear more from you today
about how VA is going to improve outreach and communication
with veterans so that future initiatives do not cause so much
confusion on the ground.
While the numbers are moving in the right direction, we
need to know that the necessary structural changes, as the
Chairman referenced, are being made as well. This is especially
important in handling the more complex claims.
The recent testimony by the office of the Inspector General
shows some of the examples of these problems. It is not
surprising these claims take longer to rate. These are also
claims for veterans who need their benefits the most and we
need to keep that in mind.
So, as VA continues to work to bring the backlog down, we
cannot prevent them from doing their jobs either. That means
keeping the government open. The entirely unnecessary shutdown
of the government forced us into some very bad circumstances
earlier this year. VA had to furlough 7,800 the VBA employees.
They ended mandatory overtime for our claims processors; and as
Secretary Shinseki testified, it decreased claims production by
an average of 1,400 claims every day.
So all of you know, Chairman Ryan and I announced our
budget agreement last night. I cannot stress enough how
important it is for everyone to help us pass this agreement so
that we can get away from governing by crisis and presenting
another government shutdown in January and protecting our
veterans as we did in the past from serious harm that we saw in
October.
So, I look forward to continuing to work with all of our
colleagues, with you, Under Secretary Hickey, and meeting the
challenges that we have.
Mr. Chairman, thank you for having this really critical
hearing.
Chairman Sanders. Well, Senator Murray, thank you and thank
you for your work on the budget process.
Senator Heller.
STATEMENT OF HON. DEAN HELLER,
U.S. SENATOR FROM NEVADA
Senator Heller. Mr. Chairman, thank you and to the Ranking
Member, thank you also for holding this hearing.
An issue that I do not think is lost on anybody is about
the critical mission facing the Veterans Benefits
Administration. I think every person in this room knows the
seriousness of this problem, but I specifically want to
underscore how this is affecting veterans in Nevada.
4,000 veterans in Reno, Las Vegas, and across Nevada are
waiting for VA target deadline of 125 days for their claim to
be completed. They are waiting more than 125 days. On average,
veterans wait 436 days to have their claims completed, which is
the longest wait of any regional office in the Nation. I think
we can all agree that this is unacceptable.
I know for a fact that, Under Secretary Hickey, you are
committed to fixing this issue, and I appreciate you
recognizing the gravity of this problem. I want to thank you
personally for your staff working with mine in trying to look
for better ways to handling these issues.
I also want to thank you for working with Senator Brown's
staff also as we try to come together with ideas to see if we
can bring this problem to an end.
It is important to me and my constituents to bring this one
particular story to your attention. A Las Vegas veteran wrote
me recently, ``I am just one more disabled veteran still
fighting the appeals process with the VA. I understand now that
no one is going to expedite my appeal, and I will probably die
before I get any successful resolution. But there are a huge
number of vets just like me and some in worse shape. None of us
deserve to be put on hold forever.''
Frustration. That is what this veteran and veterans across
the Nation are feeling. I, as well as my colleagues, want this
to be fixed for the good of our veterans. There is no doubt
about that, and I am proud to have teamed up with some of my
colleagues to thoroughly examine the claims process front to
back and from every perspective.
The reality is that VA has a 1945 process. This outdated
process no longer makes sense for VA nor for the veteran.
Looking back at two decades of VA backlog, I have found that VA
has always fixed the problem with short-term solutions rather
than asking the difficult question of whether the entire
process needs to be updated.
VA needs a 21st-century benefit delivery system for our
Nation's veterans but there is not going to be one silver
bullet, I think we can all agree, that solves this particular
problem.
It is going to take multiple proposals that address
multiple aspects of the claims process for us to really reach a
resolution but that means it is time for all stakeholders to
open up about what needs to be fixed and how to fix it.
VA has a role to play. Veterans Service Organizations and
the Congress have a role to play. Even the veterans themselves
have a part to play in resolving this. It no longer makes sense
to point fingers and to place blame as we have for quite
sometime now. Instead, Congress needs to meet and give VA and
the regional offices the tools and resources they need to bring
the backlog down but this cannot be done without an open, frank
discussion about what is working and what is not.
Congress needs to work together with VA and the VSOs to
solve this problem and solve it permanently so that this
Committee is not back here in a few years having the same
discussion.
I know the Chairman and Ranking Member are committed to
that and I will be reaching out to them with solutions or about
solutions that I have identified.
Our Nation owes it to veterans to resolve this problem and
together keep our promises to care for them when they return
home from war.
Thank you again, Under Secretary Hickey, for being here to
testify. I want to thank everybody on the panel today for
taking time for being here. I look forward to hearing about the
progress VA has made in working with you, the VSOs, and the
veterans, of course, to end this backlog.
Thank you.
Chairman Sanders. Thank you, Senator Heller.
Senator Brown.
STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown. Thank you, Mr. Chairman, I will be very
brief.
General, thank you for joining us. It is good to see you
again and I appreciate your public service as well as all of
the panel.
I appreciate the VBA transformation plan. I think the
results you outlined in your testimony are admirable and
important and positive. I echo Senator Heller and others on
this Committee that this has obviously got to improve. You know
that. We will not lecture you on that.
I will bring up in the question period something that I
still do not quite understand. The average claim has been
pending, according to VA's Monday Morning Report this week, the
average claim nationally is 167 days.
In Cleveland it is 208 days. It has persistently been the
highest second-highest, or third-highest in the country. We
have not really had good answers for that. I guess I want to
know less about why than will it be fixed.
167 days, obviously, is way too long. Another 40 days on
top of that is something that we need to work on. So, I
appreciate the work you are doing and look forward to figuring
this out.
Thank you.
Chairman Sanders. Thank you, Senator Brown.
Senator Boozman.
STATEMENT OF HON. JOHN BOOZMAN,
U.S. SENATOR FROM ARKANSAS
Senator Boozman. Thank you, Chairman and Ranking Member
Burr, for having this hearing. In the interest of time, let us
move on and I look forward to hearing the testimony of the
panel.
Chairman Sanders. Thank you very much.
Senator Begich.
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Thank you very much, Mr. Chairman. I
apologize that I will not be able to stay that long but I do
want to make a few comments.
Under Secretary Hickey, thank you and I thank VA for the
improvements. I know there have been, since I have been here,
back and forth and you have suffered through many meetings here
on this side as well as the other side.
I do want to say at least in the Alaska region things are
improving and we want to recognize that and give you credit for
that plus the hard work I know the employees there are doing.
They are under a lot of stress and I know when the shutdown
occurred it added more.
So, I appreciate the work you are doing, but I just want to
highlight for the record and also to give you a sense that even
though we are making improvements there are still some
challenges; and give you some specific cases that in a lot of
ways it is easy to find the specific cases because our office
usually gets those calls very quickly. I will give you just a
couple that I want to kind of bring to your attention.
For example, one vet that came in who was 100 percent
disabled under SSDI but only 20 percent under VA because of
their coding process, the VA's coding process, had not been
completed or updated to address the artificial discs
replacement in his back. A simple little thing, yet pretty
significant for that individual who was trying just to get
something done.
Or in the situation--because they contacted us and we moved
very quickly--the vet and his wife who literally cried on the
phone when they got their permanent total disability claim
reviewed and approved literally overnight, and the reason was
because the PTD finding allowed enrollment for the CHAMPVA
allowing his wife to be able to enroll so she could get the
necessary insurance for brain cancer that she was dealing with
and was able to ensure that she was no longer at risk or at
least limited risk of disability.
Or the vet who was found 100 percent disabled with a mental
health condition who was living in a six-by-eight room without
windows in a basement before we got his claim expedited and
approved.
Then the vet who was waiting a year to get adjustments to
their pension for adding a dependent, that is, that they got
married.
The vet whose lung cancer is attributable to Agent Orange
exposure but the COPD attributable to the lung cancer is not
considered service-connected.
Why I bring those up is because we then work at the
constituent end in trying to solve these problems. The way we
will judge the success and I will judge success of what work
you are doing is when we are not making these calls because
they are being processed without having us to make those calls.
Those examples are sometimes extreme but real and it really
puts a face on these individuals where sometimes we are in
these meetings and we talk a lot about data and statistics and
days and so forth. But really when it boils down to it, they
are individuals who are experiencing in their life the most
important thing or could be the most extreme situation.
So, I do want to echo the concern we have in trying to get
these numbers down and the timeline, but also I want to credit
your folks for the improvement over the last 4 or 5 years and
the priority you have placed on this.
We know it is not just VA. We know DOD is part of this
equation, and you have been partnered or your agency as well as
DOD have had several meetings where we have put some pressure
on them. It may have been in this Committee or in the
Appropriations Committee, trying to get this moving forward
because it is not just on your back but predominantly and
significantly you have a huge role once it is in your hands.
So, I again want to commend you for the work but also
recognize that there is still a lot more to do I appreciate
your giving me a chance to talk about these Alaskans who
everyday, you know--it is probably the largest input we get,
from veterans contacting us about their concerns and obviously
disability claims is one of those.
So, I thank you. I apologize that I will not be able to be
here for the questions and the testimony but I know our staff
is working aggressively with you. And again, your Alaska team
is working double-time and we know that and we are going to
keep some pressure on them, as you can imagine.
So, thank you very much.
Chairman Sanders. Thank you Senator Begich.
Senator Blumenthal.
STATEMENT OF HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thank you, Mr. Chairman, and thank you
for having this hearing.
First of all, General Hickey, thank you for the work that
you and VA are doing. I know that General Shinseki is
personally committed to eliminating the backlog.
I met with him, in fact, in Connecticut and had an
opportunity to talk to him about this subject. So, nothing we
say here is to imply that this backlog is the result of any
sort of malevolence or personal animus on the part of anybody
at VA. We are all grappling with a common challenge here but
there is still a lot of work to be done to reach the goal of 98
percent accuracy and an end to the backlog by 2015.
Just a few quick points. Accuracy is important. We do not
want to sacrifice accuracy for the sake of eliminating the
backlog because accuracy is itself a source of problems if it
is ignored. So, I cannot emphasize strongly enough how timing
and deadlines are important but accuracy matters to the person
on the ground.
To take one example, Michael Scovetta, a veteran who served
our country in Iraq and Afghanistan, was denied his application
after a 2-year wait; and he has now been waiting a full year
for his appeal. Obviously, the 2-year wait was regrettable but
the potential inaccuracy of his denial is also important.
I want to thank Senator Murray for her work to avoid
another shutdown because in another case the shutdown itself
aggravated the timing issue. Jordan Massa, an Iraq and
Afghanistan veteran who received a Purple Heart, had to wait
for 2 years for his application to be approved but then waited
another month due to the government shut down.
So, the point here is that different issues, challenges,
problems are interconnected and interrelated. Just to finish on
this point of talking about interrelated problems, electronic
medical records.
The Chairman has mentioned it in his opening remarks. I
have talked about it, I think, almost every opportunity in this
room at every hearing, and I want to commend VA for its
willingness to move forward, its interest in resolving these
issues.
I again express regret that the Department of Defense
apparently has been less cooperative than VA, but one way or
the other this problem has to get solved so that these records
are truly interoperable, so that the system is seamless.
There is no reason for someone leaving active duty as a
member of our United States military and then becoming ``a
veteran,'' should not have been the benefit of completely
seamless electronic medical records. And I am going to pursue
legislation.
I know the Chairman has expressed his concern and other
Members of the Committee are committed as well.
So, thank you for your work on this issue. As much as we
seem critical, and we are, we are also supportive because we
have a common goal.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you, Senator Blumenthal.
I would now like to welcome General Allison Hickey, the
Undersecretary for Benefits at VA.
General Hickey, thank you for joining us today to address
the Department's progress in eliminating the claims backlog and
what you are going to do to address the remaining very serious
problems.
We are interested in an update on the transformation
currently underway and the successes and challenges presented
by this effort.
General Hickey is accompanied by Diana Rubens, the
Associate Deputy Under Secretary for Field Operations; Brad
Houston, the Director of VBA's Office of Business Process
Integration; and Richard Hipolit, an Assistant General Counsel
in VA's Office of General Counsel.
We thank you all very much for being here.
General Hickey, please begin.
STATEMENT OF HON. ALLISON A. HICKEY, UNDER SECRETARY FOR
BENEFITS, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY
DIANA M. RUBENS, ASSOCIATE DEPUTY UNDER SECRETARY FOR FIELD
OPERATIONS, VETERANS BENEFITS ADMINISTRATION; BRAD HOUSTON,
DIRECTOR, OFFICE OF BUSINESS PROCESS INTEGRATION, VETERANS
BENEFITS ADMINISTRATION; AND RICHARD HIPOLIT, ASSISTANT GENERAL
COUNSEL, OFFICE OF GENERAL COUNSEL
Ms. Hickey. Thank you. Good morning, Chairman Sanders,
Ranking Member Burr, and Members of the Committee. Thank you
for the opportunity to update you on the Veterans Benefits
Administration's transformation efforts and progress we have
made to date.
In recent months, VA has made significant progress in
executing our Benefit Claims Transformation Plan. We reduced
the backlog impacting our veterans by approximately 36 percent
since March of this year, and we expect these reductions to
continue over the next year.
More importantly, while our employees have increased their
productivity, they have also increased the quality of their
work at the same time.
In June 2011, when I arrived, our average for claims
accuracy was approximately 83 percent; as of the end of
November 2013, the number was approximately 90 percent at the
claim level. When measuring accuracy at the medical issue
level, which is a more precise measure of VA's quality, our
rating accuracy today stands at nearly 97 percent. So, in other
words, we have done more and better for our veterans, their
families, and survivors.
That said, we continue to push closer to the Secretary's
goal of completing our veterans claims in 125 days at 98
percent accuracy in 2015. Our veterans deserve no less from us.
None of this progress would be possible were it not for the
tremendous support VA receives from its partners. This
Committee and the Congress's sustained support for VBA's budget
and legislative requirements over the last 4 years has fostered
significant headway for implementation of our plan and enabled
VBA to complete a record one million claims for 4 consecutive
years.
Our Veterans Service Organizations and labor partners and
those at the Federal, State, and local level have worked in
close collaboration with us throughout this transformation to
roll out new initiatives and provide the best possible service
to our veterans, their family members, and survivors.
Our progress would not be possible without the support of
our partners in VA Office of Information and Technology who
continue to work tirelessly to deliver new capabilities to
improve productivity and workload management; our Veterans
Health Administration partners who co-located physicians within
our regional office workforce to provide on-site support for
medical opinions and expedited claim examination at
unprecedented levels; our IRS and Social Security partners who
now provide us data every week; and our DOD partners who are
collaborating more and more to deliver the new gold standard
service treatment and personnel records and other capabilities.
Finally, but most importantly, this progress would not be
possible without the exceptionally committed tremendous effort
and dedication of VBA's employees--52 percent of these are
veterans themselves; the majority of others are direct family
members of a veteran.
They have each worked tirelessly in mandatory overtime for
the last 8 months serving veterans, their families, and
survivors by working an additional 20 hours every month for
those 8 months. Many employees continue to work overtime in
voluntary status even now.
Let me highlight some key outcome statistics as of December
7 that show our progress: inventory, down from a peak of
884,000 to 693,000 or 191,000 claims down, 22 percent reduced;
backlog, down from a peak of 611,000 in March 2013 to 395,000,
a decrease of 216,000 or 36 percent. Nearly one-third of the
backlog is gone.
Claim level accuracy increased from approximately 83
percent in 2011 to 90 percent today.
Medical issue accuracy is approximate 97 percent today. We
cut our B2, or exam errors, by 50 percent across the Nation by
focusing on them hard this year. We trained over 3,500
employees through the new challenge training where they rate
claims 150 percent faster and are 30 percent more accurate at
the end of the training.
We have completed more than 45,000 reviews by our quality
review teams to catch errors earlier in the process before a
final outcome for the veteran, avoiding those errors in the
outcomes.
We have completed 1.17 million claims in fiscal year 2013,
an all-time historic high for VBA and 4 months of record-
breaking production.
We completed 99.9 percent of all claims older than 2 years;
67,000 veterans waiting the longest now have a quality
decision. We completed over 96 percent of all claims in the 1-
year-old category from 513,000 veterans in April of this year
to approximately 18,000 that remain.
We have already completed 61 percent of all claims older
than 334 days, our next tranche. We will continue to drive the
age of these claims down until we hit 125 and, and 98 percent
quality in 2015.
You can see it for yourself in our Monday Morning Workload
Report where our pending workload today is, on average, 100
days younger than it was this time last year.
We have also fully implemented one of our people
initiatives, our new Transformational Organizational Model in
all 56 regional offices 9 months ahead of schedule and are
seeing a 10 percent increase in production as we predicted in
the plan.
We built the Stakeholder Enterprise Portal and granted
1,148 credentials to our VSO partners, representing over 75
organizations. We are currently building and testing the
capability to connect digit-to-digits with their electronic
claims submission systems, as well.
We grew our fully-develop claims receipts from 3 to 27
percent since February because of our great partnerships with
our VSOs. We are even seeing some VSOs take the fully develop
claims issue to new levels providing even the Federal records
and exams completed in a disability benefit questionnaire, or
DBQ, making these claims ready to rate.
We have VHA physicians in our regional offices now
providing just-in-time medical opinions, DBQs, acceptable
clinical evidence or ACE exams, and simple time-saving, quick
on-the-spot answers to raters who need clarification.
We have supported over 3.2 million active accounts in
eBenefits up from 250,000 in June 2011 and now eBenefits hosts
50 self-service features including over the last year the
ability to file a claim online, upload your own evidence, and
submit your claim directly into a VBMS. When I last spoke to
you, we had received a total of 1,500 claims this way. Today,
we receive 1,000 a week this way.
We deployed VBMS to every regional office, medical center,
records management center, appeals management center a full 6
months ahead of schedule. Under the original VBMS
transformation plan, we would still be delivering VBMS to
regional offices for the first time this month.
Instead, we have more than 25,000 users and have converted
more than 360 million images from paper into digital format at
a 99 percent quality level.
We have created or converted 75 percent of our current
claims in the inventory into the digital format for processing
electronically in the new VBMS system.
We have established the Newark Regional Office as a model
for an electronic regional office or eRO, to test and validate
the changes associated with converting to a completely
paperless operation so we see no surprises.
Despite these recent outcome metrics and success, please
know this, Mr. Chairman and Members of this Committee, we still
recognize that many veterans wait too long to receive the
benefits that they have earned and deserved. This has never
been acceptable to VA and it remains unacceptable to VA.
No one in VBA is ``taking a knee'' as we would have said in
our military careers and the combined effects of our
transformation plan are having a positive impact for many of
our veterans, their families, and survivors.
I thank this Committee for your continued support
especially as we move into our crucial fiscal year--2014.
[The prepared statement of Ms. Hickey follows:]
Prepared Statement of Allison A. Hickey, Under Secretary for Benefits,
Veterans Benefits Administration (VBA), U.S. Department of Veterans
Affairs (VA)
Good morning, Chairman Sanders, Ranking Member Burr, and Members of
the Committee. Thank you for the opportunity to discuss VA's benefits
claims processing transformation efforts. I am accompanied today by
Richard Hipolit, Assistant General Counsel, Brad Houston, Director of
VBA's Office of Business Process Integration, and Diana Rubens, VBA's
Deputy Under Secretary for Field Operations.
In recent months, VA has made significant progress in executing our
benefit claims Transformation Plan. We reduced the backlog by
approximately 36 percent since March of this year, and we expect these
reductions to continue over the next year. More importantly, while
increasing our productivity, we have also increased the quality of our
work. In June 2011, when I arrived, our average for claims accuracy was
approximately 83 percent; as of the end of November 2013, that number
was approximately 90 percent. When measuring accuracy at the medical
issue level--which is a more precise measure of VA's workload--our
rating accuracy today stands at 97 percent. My testimony today will
focus on how execution of our Transformation Plan has decreased the
backlog and increased quality, resulting in better service to the
Veteran community and pushing us closer to the Secretary's goal of all
claims completed in 125 days at 98-percent accuracy in 2015.
None of this progress would be possible were it not for the
tremendous support VA receives from its partners. The direct support of
this Committee and the Congress has helped us make significant headway
on our Transformation Plan and enabled us to complete a record-breaking
1 million claims for 4 consecutive years. Our Veterans Service
Organization (VSO) partners have worked in close collaboration with us
throughout this transformation to roll out new initiatives and provide
the best service possible to our Veterans, their family members, and
Survivors. Our State Departments of Veterans Affairs partners across
the country have helped us reduce the backlog at a local level by
contributing resources to innovative Federal/state solutions. Our
progress would not be possible without the support of our partners in
the VA Office of Information and Technology, who continue to work
tirelessly to deliver new capabilities to improve productivity and
workload management, and our Veterans Health Administration (VHA)
partners, who co-located physicians with our regional office workforce
to provide onsite support for medical opinions and expedited claim
examinations at unprecedented levels. Finally, this progress would not
be possible without the tremendous effort and dedication of VBA's
claims processing employees, who worked mandatory overtime for 6 months
straight on this important mission.
vba transformation plan: results through november 30, 2013
Here are some key statistics that show our progress:
Inventory: Down from peak of 884,000 in July 2012 to
693,000--a decrease of 191,000 or 22 percent
Backlog: Down from peak of 611,000 in March 2013 to
392,000--a decrease of 219,000 or 36 percent
``1-Year Claims'' Initiative: Approximately 96 percent
complete from 513,000 in April 2013 to 20,000
Claim-Level Accuracy (12-month): Increased from
approximately 83 percent in 2011 to 90 percent today
Medical-Issue Accuracy (3-month): Approximately 97 percent
Completed 1.17 million claims in Fiscal Year (FY) 2013--an
all-time high Completed 128,000 claims in August and 129,000 in
September--an all-time high
Recognized the 1 millionth GI Bill recipient in
November 2013; approximately 82 percent of supplemental claims are now
either fully or partially automated
Granted 1,148 credentials to VSOs to use Stakeholder
Enterprise Portal
Approximately 75 percent of current claims in the
inventory are in digital format for processing electronically within
the Veterans Benefits Management System
Converted more than 360 million images from paper into
digital format
Supporting over 3.2 million active accounts in eBenefits
Despite these recent successes, many Veterans still wait too long
to receive benefits they have earned and deserve. This has never been
acceptable to VA or to the dedicated employees of VBA--approximately 52
percent of whom are Veterans themselves. As this Committee knows from
our previous discussions, VA's Transformation Plan includes initiatives
to re-train and reorganize our people, streamline our business
processes, and build and implement new technology solutions that are
getting us out of paper-bound, manual processes to improve our service
to Veterans, their families, and Survivors. There is no silver bullet
in this Transformation Plan; the results being reported today cannot be
attributed to any one single initiative or program but rather the
collective synergy of all of them. However, I would like to take this
time to review a few key initiatives that have had a significant impact
on our increased production and quality and show promise for the way
ahead.
vba organizational model
Initially planned for deployment throughout FY 2013, VBA
accelerated the implementation of its new organizational model by 9
months due to early indications of its positive impact on performance.
The new organizational model incorporates a case-management approach to
claims processing, by reorganizing the workforce into cross-functional
teams that give employees visibility of the entire processing cycle of
a Veteran's claim. These cross-functional teams work together on one of
three segmented lanes: express, special operations, or core. Lanes were
created based on the complexity and priority of the claims, and
employees are assigned to the lanes based on their experience and skill
levels. An Intake Processing Center serves as a formalized triage
process to quickly and accurately route Veterans' claims to the right
lane when first received.
The Express Lane was developed to identify those claims with a
limited number of medical conditions (i.e., about 1-2 issues) and
subject matter which could be developed and rated more quickly. The
Special Operations Lane applies intense focus and case management on
specific categories of claims that require special processing or
training (e.g., homeless or terminally-ill Veterans, military sexual
trauma, former prisoners of war, seriously injured, etc.). The Core
Lane includes claims with three or more medical issues that do not
involve special populations of Veterans. Less complex claims move
quickly through the system in the Express Lane, and the quality of our
decisions improves by assigning more experienced and skilled employees
to the more complex claims in our Special Operations Lane.
Thus far, we have seen a 10-percent increase in production in
regional offices using the new model during the first 60 days of
deployment. We have also seen processing speed in our Express Lanes
improve; about 30 percent of claims are routed through Express Lanes
and are being processed about 100 days faster than claims routed
through Special Operations Lanes (approximately 10 percent of claims)
or the Core Lanes (approximately 60 percent of claims).
veterans benefits management system (vbms)
VBMS, VA's Web-based electronic claims processing solution, was
fully deployed to all 56 regional offices 6 months ahead of schedule in
June 2013. Since then, VBA has also successfully deployed VBMS to the
Appeals Management Center, the Records Management Center, the Board of
Veterans' Appeals, all National Call Centers, and all VA medical
centers. This new technology helps us get out of paper and begin
reaping gains in processing speed within a digital claims processing
environment; currently, more than 75 percent of our existing claims
inventory is electronic and will be processed electronically. In
addition, VBMS improves access, drives automation, and enables greater
exchange of information and increased transparency to Veterans, our
workforce, and our stakeholders.
The evolution of VBMS is occurring across four distinct generations
of development. Generation One of VBMS began in 2010 with the
conceptualization, piloting, development, and deployment of baseline
system functionality with improved quality and efficiency. The
development of Generation One of VBMS concluded with the successful
implementation of Release 4.1 in January 2013.
As we moved into the development of Generation Two of VBMS, the
focus has been on building additional system capabilities while
leveraging simple automation features. VBA has deployed three major
Generation Two software releases: VBMS 4.2, 5.0, and 5.1. These
releases included improvements to correspondence and work queue tools,
additional rating functionality, and more extensive data exchange and
system integration capabilities.
VBMS 6.0, scheduled for release this month, will enhance existing
features, integrate additional correspondence functionality, deliver
initial capabilities to the Board of Veterans' Appeals, and add new
functionality to allow claims processors to electronically request and
receive service treatment records from the Department of Defense (DOD)
Healthcare Artifacts and Image Management Solution (HAIMS).
Generation Three of VBMS, which will deploy in 2014, will increase
system functionality, add more complex automation capabilities, and
have the capability to accept Veterans' electronic service treatment
records and personnel records from DOD. Additional workload management
capabilities will also allow VBA to move claims electronically across
regional office boundaries when needed. A national work queue is being
developed based on this capability, which will route claims
automatically based on VBA's priorities and essentially match a claims
processor with the ``next best claim'' to work based on their skill
level and national policy. All of these improvements will enable VBMS
end-users, which include VA Medical Center personnel and VSOs, to
perform their work more efficiently and accurately.
Enhancements to system capabilities in 2014 will increase both the
production and quality of our claims decisions. In this year, VA will
also have an additional opportunity to assess and validate the
effectiveness of the model as a whole and implement improvements as
needed.
Generation Four of VBMS, which will deploy in 2015, will capitalize
on efficiencies and quality improvements gained during the previous
year. VA will utilize enhancements made in Generation Three to identify
additional automation and process improvement opportunities that can be
incorporated into Generation Four, allowing employees to focus on more
difficult claims by reducing the time required to process less complex
claims.
VBA established the Veterans Claims Intake Program (VCIP) in 2012
to streamline the process for receiving records and data into VBMS and
other VBA systems. VCIP converts claims and other paper records that we
receive into a digital format that is usable within VBMS. Under VCIP,
documents are scanned and converted into electronic format, and
important information and data are extracted and populated in an
electronic folder accessible to claims processors through VBMS. In
November 2013, VCIP achieved a major milestone by surpassing 350
million images converted from paper and uploaded into VBMS.
ebenefits and the stakeholder enterprise portal (sep)
eBenefits is a joint VA/DOD client services portal that provides
life-long engagement with Servicemembers, Veterans, and their families.
VA has been strongly encouraging the use of eBenefits since
October 2009, and just recently crossed the three-million-user mark.
eBenefits users have access to more than 50 self-service features and
greater access to benefits and health information at the time and
method of their choosing. Through self-service, eBenefits users have
generated over 370,000 requests for official military personnel
documents, 379,000 requests for VA guaranteed home loan certificates of
eligibility, approximately 29.1 million claim status requests, and over
3.2 million self-service letters. VA will continue to add more
functionality and features to the site, with the goal of using it to
anticipate Veterans' needs, prompt them when they're eligible for new
benefits and services, and ultimately reach out to them instead of
waiting until they reach out to us.
The integration of eBenefits with VBMS also enables Veterans to
submit claims online. Using the Veterans On-line Application (VONAPP)
Direct Connect (VDC) application in eBenefits, Veterans can file a
claim online by answering a series of questions (which may seem
familiar to users of today's tax preparation software like Turbo Tax),
upload all their evidence and supporting documents, check the status of
their claims, and much more. The electronic claims submission
capability provided by VDC improves the timeliness of claims processing
by leaping over the entire paper-based mail, triage, and claims
establishment process. Claims filed in eBenefits feed right into VBMS,
giving employees the ability to work these claims without ever having
to touch a piece of paper. Today, VA receives about 1,000 claims each
week through VDC. We are grateful for the support of all our partners--
in the Congress, at the state and national VSO level, and in every
State Department of Veterans Affairs across the country--for
encouraging Veterans to use eBenefits and submit their claims
electronically, which boosts productivity and helps us eliminate the
backlog. VA distributed toolkits with information on eBenefits and
fully developed claims (FDCs) to every Congressional office. eBenefits
prompts Veterans to file FDCs when they submit a claim online and
outlines the advantages in terms of improved decision timeliness. We
ask that you continue to partner with us on promoting these important
initiatives to Veterans in your states by adding information to your
Web pages and in correspondence to constituents who are Veterans.
The third component of our online engagement strategy is the
Stakeholder Enterprise Portal (SEP), which is a secure, Web-based
connection that complements eBenefits and gives VSOs and other
authorized advocates access to assist Veterans in filing disability
claims electronically. Using the portal, VSOs can check the status of
claims, review payment history, and upload documentation on behalf of
the Veterans they represent--all within a digital environment. When
filing a claim online in eBenefits, a Veteran can request the
assistance of a VSO by choosing from a list of accredited
representatives in VA's database. When logging into SEP, the chosen VSO
representative is alerted to the Veteran's request, and upon
acceptance, is given power-of-attorney authorization to access the
Veteran's claim and assist with preparation. Once the VSO
representative believes the claim is ready for submission, he or she
can send notification back to the Veteran in eBenefits, and the Veteran
submits the claim to VA. With SEP, 8,000 VSO representatives throughout
the Nation can continue to perform their vital advocacy and assistance
role within VA's transformed benefits delivery model. As of
November 30, 2013, VA has registered more than 14 percent of all VSOs.
electronic regional office (ero)
On November 1, 2013, VBA established the Newark Regional Office as
the first eRO. There are no longer any paper claims being processed at
the Newark eRO. All claims are processed electronically, which allows
us to refine, test, and streamline our operations as we prepare for a
fully electronic environment nationwide. Veterans, Survivors, and
families served by the Newark eRO do not experience any change in the
way they interact with the Newark RO. Claims submitted in paper format
continue to be accepted but are scanned and immediately entered into
VBMS for electronic processing. We anticipate all 56 regional offices
will be in a fully electronic environment later this year. Modeling the
eRO at the Newark RO will enable us to understand the impacts on our
current operations and help to ensure we have planned for a smooth
transition. We continue to encourage all Veterans to file claims
electronically through eBenefits and to utilize Veterans service
organizations to assist them with their claims.
fully-developed claims (fdc)
VA's FDC program is a critical tool for transforming the way we do
business. The longest phase of the current claims-processing timeline
is the phase in which VBA employees gather evidence. FDCs drastically
reduce the length of this phase by allowing Veterans to submit claims
as ``fully developed,'' which means the claim includes all available
supporting evidence like private treatment records, a notice of any
other records held in Federal facilities, and a certification that the
Veteran has no more evidence to submit. Veterans are not at any risk
when submitting an FDC, because if we find that there is another piece
of relevant evidence that is needed for a rating decision, our
employees will work to obtain it on the Veteran's behalf and continue
processing the claim.
The Congress and our state and VSO partners have been instrumental
in helping us increase awareness and understanding of our FDC program,
especially by supporting the FDC workshops we have conducted across the
country. As a result of these efforts and many others, the use of FDCs
has dramatically improved since last year. In the third quarter of FY
2012, VA received approximately 3.6 percent of all claims as FDCs; in
the fourth quarter of FY 2013, we received almost 25 percent of all
claims as FDCs. FDCs are currently processed in less than half of the
time it takes to process non-FDCs.
challenge training and quality review teams (qrts)
VBA is committed to providing high quality, timely, and relevant
training for both new and experienced personnel to ensure that claims
quality continues to improve. To this end, our transformation efforts
include redesigned programs and tools that standardize training for the
disability compensation and pension benefit programs across our 56
regional offices.
VBA instituted national-level Challenge Training in 2011 and
Quality Review Teams (QRTs) in 2012 to improve employee training and
decision accuracy while decreasing rework time. Challenge Training is
focused on building the overall skills and readiness of the workforce
through an 8-week curriculum, and QRTs focus on fixing the most common
sources of error in the claims-processing cycle. To date, approximately
3,000 employees have graduated from our Challenge Training program, and
an additional 484 employees have undergone Station Enhancement Training
(SET), which is based on the Challenge model for new employees. In FY
2013, rating accuracy for claims completed in Challenge training was
95.5 percent.
Evidence shows that these training sessions are having a
significant impact on accuracy, timeliness, and production. Challenge
graduates decide approximately 150 percent more claims per day than
their predecessor cohorts, at 30-percent better accuracy. Before
Challenge Training, employees processed about half a claim a day at
approximately 60-percent accuracy during the first 6 months following
graduation; today, claims processors trained under the new Challenge
program complete about 1.6 claims a day at approximately 94-percent
accuracy within 6 weeks of graduation. In addition, when an entire
regional office undergoes SET, accuracy improves by approximately 8
percent, and monthly production improves by approximately 27 percent.
In 2012, VBA reassigned 573 of our most skilled and experienced
employees from their duties as claims processors to serve on QRTs. In
FY 2013, these QRTs conducted more than 145,000 in-process reviews,
preventing errors before they can impact the Veteran and providing
specialized re-training to claims processors so these errors can be
prevented in the future. QRTs made a particularly big impact on the
most common types of errors this year.
In 2012, VBA found that almost 40 percent of claims rework errors
across VBA were occurring in the medical examination phase (identified
as ``B2'' errors). In April 2012, we launched the B2 Error Reduction
Initiative and trained QRT Coaches to lead a Lean Six Sigma project at
their regional offices to reduce B2 errors by approximately 50 percent.
We made the investment--both by taking 573 employees off the line to
serve on the QRTs and by training every QRT coach in Lean Six Sigma--
and we are now seeing the results. In FY 2013, we reduced the B2 error
rate by more than 40 percent across all of VBA, which means Veterans
will not have to wait as long for a decision on their claims, and they
will receive a high-quality decision.
VA currently uses a 3-month rolling average to track the impact of
these initiatives, and others like them, on rating accuracy. These
metrics are reported in ASPIRE, the monthly Dashboard providing
information on how VBA and regional offices are doing in relation to
2015 aspirational goals, and can be seen online (www.vba.va.gov/
reports/) by anyone inside or outside of VA. In FY 2012, VA showed a 3-
percent increase in national accuracy--from approximately 83 percent to
86 percent. In FY 2013, our 3-month accuracy at the claims level rose
to approximately 90 percent, meeting the goal we set for ourselves this
year. The accuracy outcome goals for the next 2 years are approximately
93 percent in FY 2014 and 98 percent in FY 2015.
It is important to recognize that under the existing quality review
system, any one error on the claim, no matter how many medical
conditions must be developed and evaluated, makes the entire claim in
error--the claim is therefore counted as either 100 percent accurate or
100 percent in error, with no credit for anything in between. Medical
issues are defined as individually evaluated medical conditions. Given
that the average number of medical issues included in each claim for
recently separated Servicemembers is now in the 12 to 16 range, we do
not believe the current all-or-nothing measure reflects the actual
level of decision accuracy achieved. When we measure the quality of
claims based on the individual medical issues rated (i.e., ``issue-
based accuracy''), the accuracy of our decisions is at approximately 97
percent. This issue-based accuracy approach also affords VBA the
opportunity to precisely target those medical issues where we make the
most errors, at the individual employee level, and develop and direct
training in a targeted manner.
collaborations and partnerships
VBA is relying more and more on partnerships with Federal, state
and non-profit agencies to improve benefits delivery for Veterans. A
key component of VBA's transformation is leveraging technology to
interface with partners to securely exchange Veteran information needed
to verify benefits eligibility. Over the past year, VBA has worked to
develop these interfaces with the agencies below, and steady progress
is being made.
Defense Department Service Treatment Records
DOD continues to strive to provide VA with 100 percent of
separating Servicemembers' complete and certified Service Treatment
Records. During the third week of November 2013, DOD achieved a 90-
percent certification rate. VBA continues to work with DOD to
transition to receiving all Service Treatment Records electronically.
This will be accomplished via HAIMS to VBMS interface, which is
scheduled for implementation effective January 1, 2014.
Internal Revenue Service (IRS) and Social Security Administration (SSA)
Data Sharing
In February 2013, VA developed an expanded data-sharing initiative
with IRS and SSA to streamline income verification for pension
applicants. This initiative enabled VBA to eliminate an annual
reporting surge of 150,000 actions and redirect significant resources
to address the backlog of dependency and indemnity compensation (DIC)
claims from Survivors. As a result, we have doubled our output of DIC
claims processing with this effort, cutting the inventory in half and
ensuring approximately 74 percent of all DIC claims are completed
within 125 days.
VSOs and State and County Service Officers
Currently, VA's Digits-to-Digits (D2D) project allows VSOs, County
Veterans representatives, and State Veterans Affairs agencies to
directly submit electronic compensation claims into VA's digital claims
system using their own existing systems. Allowing our partners this
connectivity dramatically increases access to VA for Veterans and their
advocates. We have already seen six claims management software
providers build to VA's D2D specifications to make their products more
competitive to their customer base of VSOs and County and State
Veterans Affairs agencies. This path is very similar to the online tax
preparation model provided by IRS, in which IRS published technology
standards and specifications for how to send/receive data and then
allowed the private sector to develop solutions for their customers to
file their tax returns with IRS. While D2D is currently focused on
digital submission of disability claims, this model can be extended to
other benefits delivery programs in VA.
oldest claims initiative
On April 19, 2013, VBA began to implement a special initiative to
quickly decide the oldest claims in the inventory. This initiative was
created to accelerate the elimination of the backlog for Veterans who
have waited the longest for a decision, and is a key part of VA's
overall strategy to eliminate the claims backlog in 2015.
In June, VA completed the first phase of the initiative, which
focused on all claims that had been pending over 2 years. While some
claims from that category were still outstanding due to the
unavailability of a claimant and other unique circumstances,
approximately 99 percent of these 2-year claims (over 67,000) had been
processed for Veterans, eliminating those claims from the backlog.
Since that milestone, VBA claims processors have focused on completing
the claims of Veterans who have been waiting over 1 year for a
decision. VA has processed approximately 96 percent of all 513,000
claims pending over 1 year.
Several key factors have made this important initiative a success:
Veterans Health Administration (VHA) Collaboration. First, the
contribution of our VHA partners has been critical. During this period,
VHA physicians have been working in each of VBA's regional offices to
provide onsite support for medical opinions, reducing deferral rates
and increasing efficiency. They have been a key node in the management
process by tracking those medical exams that are needed for rating
decisions and ensuring the information is flowing between the
administrations.
Mandatory Overtime. Mandatory overtime is a management tool that
VBA implemented starting May 20, 2013, to maximize productivity during
the oldest claim initiative. While in mandatory overtime, Rating
Veterans Service Representatives (RVSRs), Veterans Service
Representatives (VSRs), and Decision Review Officers (DROs) worked a
minimum of 20 hours of overtime per month and focused exclusively on
completing priority claims--claims over 1 year, FDCs, and special-
interest claims (homeless, hardship, former prisoner of war, terminally
ill, etc.). From May 20 to September 30, 2013, VBA's daily rating
production increased over 30 percent, or more than 1,000 additional
claims per day. VBA also recorded its highest monthly production rates
ever in August and September 2013--over 128,000 and 129,000
respectively. Mandatory overtime was halted during the 2-week
Government shutdown in October but was re-established and continued
through November 23, 2013. VBA anticipates mandatory overtime to resume
in 2014, contingent upon available funding. Optional overtime for
claims processors will remain in effect.
National-level Workload Management. The oldest claims initiative
also validated the need for a national approach to workload management.
Historically VBA has maintained regional office claims processing
jurisdictions that are aligned with state boundaries. This results in
less-than-optimal utilization of VBA claims processing capacity. In
recent years, VBA has ``brokered'' claims between regional offices via
file transfer in order to maximize national claims processing
resources. During VBA's focus on the oldest claims, more than 100,000
claims were brokered, ensuring the right ``next claim'' is matched with
resources available nationwide. When the full system capacity is
leveraged and state boundaries are disregarded, VBA achieves a much
higher level of production.
The future state of VBA's brokering capabilities lies in the
continued development of VBMS and a workload that is entirely
electronic. The workload management capabilities of VBMS are being
developed in two steps. Currently, a working group is building the
design requirements that will provide managers with the tools and
reporting capabilities to manage their workload most effectively at the
regional office level. Second, a national work queue is being
developed, to include the capability to route claims automatically
through a pre-determined set of logic that matches claims processors
with the ``next best claim'' to work, based on their skills and
competencies and nationally set priorities.
Improved Production and Increased Accuracy. The results of our
transformation efforts, including the oldest claims initiative, have
proven that increased production does not have to come at the expense
of decision quality. During this recent period of unprecedented
production, VBA's 3-month rolling average for claims accuracy has
steadily improved, from approximately 86 percent at the beginning of
the year, increasing to 90 percent as of the end of November 2013.
Issue-level accuracy has improved to approximately 97 percent.
August 2013 proved to be the most productive month in VBA history for
claims processing--with 128,594 claims completed--and in September our
performance was even stronger, completing 129,488 claims.
conclusion
While we know there is much more work to be done to reach our
goals, the combined effects of our Transformation Plan--the people,
process, and technology innovations and initiatives that have been
developed and deployed--are having an impact. The gains we are making
in information technology and the automation of our processes are
critical, and going forward, we will need to sustain the resources for
programs like VBMS in order to eliminate the backlog in 2015 and
achieve our quality goals. Much of our success is attributable to the
support of this Committee and your commitment to helping us in our
transformation. I thank you for that--and for your full support of our
information technology budgets. FY 2014 is a crucial year in our
transformation, and I look forward to your continued support and
commitment on behalf of Veterans, their families, and Survivors.
______
Response to Prehearing Questions Submitted by Hon. Richard Burr to
U.S. Department of Veterans Affairs
Question 1. In April 2013, VA announced an initiative to focus on
claims that have been pending for at least one year, called its Oldest
Claims First Initiative.
a. In total, how many claims were included in this initiative?
VBA Response: VBA's Oldest Claims First initiative included 512,942
claims. Through December 5, almost 495,000 of 512,942 of the oldest
claims have been completed (96.5 percent), reducing the over-one-year
claims remaining to be worked under this initiative to 18,005 (3.5
percent).
VBA previously submitted a response to this question that may have
been confusing and only included information through September 30,
2013. The numbers above reflect information as of December 5, 2013.
b. Of those, how many claims have received a final decision and how
many have received a provisional decision?
VBA Response: Through November 8, 2013, a total of 14,871 claims
received a provisional rating, including 7,513 2-year claims and 7,358
1-year claims. This represents approximately two percent of the rating-
related decisions made under the Oldest Claims Initiative through
November 8, 2013. The use of provisional rating decisions ended on
November 8, 2013.
c. Please provide redacted copies of at least ten provisional
decisions that have been issued in connection with this initiative.
VBA Response: VA provided 10 copies of provisional decisions to the
Committee on 12/09/2013. Due to file size, these were delivered on CD.
[Redacted submissions were received and are being held in Committee
files.]
Question 2. According to the Monday Morning Workload Report, the
number of items pending under End Product (EP) 400 (Correspondence)
increased from less than 5,200 in September 2010 to over 70,500 in
September 2013.
a. For the hearing record, please explain what work items are
included under EP 400 and whether it includes claims that received
provisional decisions under VA's Oldest Claims First Initiative.
VBA Response: Traditionally, VBA utilized the EP 400 to track
correspondence actions that did not require a decision and only
required a written response (e.g., a letter requesting the status of a
claim).
In fiscal year 2011, VBA expanded the use of EP 400 to track two
types of claims filed under the 2009 Agent Orange presumption policy
change.
On April 19, 2013, VBA once again expanded its use of the EP 400 to
track a subset of claims completed during the Oldest Claims Initiative.
EP 400, with an additional tracking label, is used to identify claims
that received a provisional rating decision for claimants who are both
in receipt and not in receipt of VA benefits at the time of the
decision.
b. Are any of the work items reflected under EP 400 included in
VA's statistics on the backlog of claims that VA aims to eliminate by
2015?
VBA Response: EP 400 is not included in VA's statistics on the
backlog of claims. VBA has defined the ``backlog,'' as rating claims
pending greater than 125 days. Rating claims are considered claims for
disability compensation, dependency and indemnity compensation, and
Veterans' pension benefits, including both original and supplemental
claims. Rating claims generally require a disability rating decision by
a Rating Veterans Service Representative.
Question 3. According to the Monday Morning Workload Report, the
number of items pending under EP 930 (Review, including quality
assurance) increased from less than 14,700 in September 2010 to over
26,500 in September 2013.
a. For the hearing record, please explain what work items are
included under EP 930 and whether it includes claims that received
provisional decisions under VA's Oldest Claims First Initiative.
VBA Response: Traditionally, EP 930 was used to track completed
claims that subsequently require review, such as quality assurance
reviews or award corrections. Because VA had already taken rating end-
product credit on these claims, reviews or corrective actions are
tracked in this ``non-credit'' series.
On April 19, 2013, VBA expanded its use of EP 930 to track a subset
of claims completed during the Oldest Claims Initiative. EP 930, with a
date of claim 364 days from the date of the provisional rating
decision, identifies provisional rating decisions issued to claimants
not in receipt of VA benefits at the time of the decision. This end
product was established to ensure a final rating decision is issued to
these claimants.
b. Are any of the work items reflected under EP 930 included in
VA's statistics on the backlog of claims that VA aims to eliminate by
2015?
VBA Response: Actions pending under EP 930 are not included in VA's
statistics on the backlog of claims. VBA has defined the ``backlog'' as
rating claims pending greater than 125 days. Rating claims are
considered claims for disability compensation, dependency and indemnity
compensation, and Veterans' pension benefits, including both original
and supplemental claims. Rating claims generally require a disability
rating decision by a Rating Veterans Service Representative.
Question 4. According to the Monday Morning Workload Report, the
number of items pending under EP 130 (Dependency) increased from less
than 49,000 in September 2010 to over 210,000 in September 2013 and
nearly 72 percent of those 210,000 work items have been pending for
more than 125 days.
a. Please explain what work items are included under EP 130.
VBA Response: EP 130 applies to all actions involving dependency
determinations, where the primary issue involves entitlement of the
Veteran to increased benefits based on relationship or dependency.
b. During that time, has VA suspended work on these items or placed
a lower priority on this work?
VBA Response: VBA completed a record number of non-rating claims in
FY 2013 (875k), which includes EP 130 dependency claims. This is a 16%
increase over FY12.
c. Are any of the work items reflected under EP 130 included in
VA's statistics on the backlog of claims that VA aims to eliminate by
2015?
VBA Response: EP 130 is not included in VA's statistics on the
backlog of claims. VBA has defined the ``backlog,'' as rating claims
pending greater than 125 days. Rating claims are considered claims for
disability compensation, dependency and indemnity compensation, and
Veterans' pension benefits, including both original and supplemental
claims. Rating claims generally require a disability rating decision by
a Rating Veterans Service Representative.
Question 5. According to the Monday Morning Workload Report, the
number of items pending under EP 290 (Misc. determinations) increased
from less than 27,000 in September 2010 to over 87,000 in
September 2013 and 83 percent of those 87,000 work items have been
pending for more than 125 days.
a. Please explain what work items are included under EP 290.
VBA Response: EP 290 applies to adjudicative decisions relating to
eligibility benefits under other VA programs; programs of other Federal
and State agencies; and independent determinations relating to
elections, waivers, guardianship issues and other issues affecting
payments. Examples of EP 290 work include adjustments due to
incarcerations, claims for clothing allowance, and eligibility for loan
guaranty benefits.
b. During that time, has VA suspended work on these items or placed
a lower priority on this work?
VBA Response: VBA completed a record number of non-rating claims in
FY 2013 (875k), which includes EP 290 claims. This is a 16% increase
over FY12.
c. Are any of the work items reflected under EP 290 included in
VA's statistics on the backlog of claims that VA aims to eliminate by
2015?
VBA Response: EP 290 is not included in VA's statistics on the
backlog of claims. VBA has defined the ``backlog,'' as rating claims
pending greater than 125 days. Rating claims are considered claims for
disability compensation, dependency and indemnity compensation, and
Veterans' pension benefits, including both original and supplemental
claims. Rating claims generally require a disability rating decision by
a Rating Veterans Service Representative.
Question 6. According to the Monday Morning Workload Report, the
number of items pending under EP 600 (Due process) increased from less
than 20,000 in September 2010 to over 52,700 in September 2013 and 52
percent of those 52,700 work items have been pending for more than 125
days.
a. Please explain what work items are included under EP 600.
VBA Response: EP 600 can be used for two different types of VBA
actions. Most often, EP 600 identifies cases where a predetermination
notice is provided to a VBA beneficiary proposing to reduce benefits.
EP 600 can also be applied to claims where VA proposes to find the
claimant unfit to manage their VBA benefits.
b. During that time, has VA suspended work on these items or placed
a lower priority on this work?
VBA Response: VBA completed a record number of non-rating claims in
FY 2013 (875k), which includes EP 600 claims. This is a 16% increase
over FY12.
c. Are any of the work items reflected under EP 600 included in
VA's statistics on the backlog of claims that VA aims to eliminate by
2015?
VBA Response: EP 600 is not included in VA's statistics on the
backlog of claims. VBA has defined the ``backlog,'' as rating claims
pending greater than 125 days. Rating claims are considered claims for
disability compensation, dependency and indemnity compensation, and
Veterans' pension benefits, including both original and supplemental
claims. Rating claims generally require a disability rating decision by
a Rating Veterans Service Representative.
Question 7. According to the Monday Morning Workload Report, the
number of items pending under EP 165 (Accrued) increased from less than
3,700 in September 2010 to over 15,300 in September 2013.
a. Please explain the nature of the work items included under EP
165.
VBA Response: EP 165 applies to claims for compensation or pension
payable as reimbursement of the expenses of last sickness and burial,
or claims for accrued benefits payable based on relationship.
b. During that time, has VA suspended work on these items or placed
a lower priority on this work?
VBA Response: VBA completed a record number of non-rating claims in
FY 2013 (875k), which includes EP 165 claims. This is a 16% increase
over FY12.
c. Are any of the work items reflected under EP 165 included in
VA's statistics on the backlog of claims that VA aims to eliminate by
2015?
VBA Response: EP 165 is not included in VA's statistics on the
backlog of claims. VBA has defined the ``backlog,'' as rating claims
pending greater than 125 days. Rating claims are considered claims for
disability compensation, dependency and indemnity compensation, and
Veterans' pension benefits, including both original and supplemental
claims. Rating claims generally require a disability rating decision by
a Rating Veterans Service Representative.
______
Response to Posthearing Questions Submitted by Hon. Bernard Sanders to
U.S. Department of Veterans Affairs
Question 1. During the hearing Under Secretary Hickey testified
that veterans were able to access VONAPP to file pension claims using a
portal at the bottom of the Pension Home Page on VA's Internet site.
However, according to the information on this site pension claims must
be submitted in paper form. There is a link on the Pension Home Page to
allow veterans to obtain and print out a pension application for paper
submission. The page states: ``This application will need to be
completed and mailed to the appropriate VA Regional Office based on the
state in which you reside.''
Please clarify the ability of veterans to file pension claims on-
line, including any timetable for restoration of on-line applications
for pension claims in VONAPP, e-Benefits or any other portal.
Response. Veterans wishing to apply for pension do not currently
have the capability to apply online. However, the application for
pension remains available for download and printing through the VA
pension Web site. While VA only received 30 pension claims per month
through the VONAPP system, we agree that it is necessary to maintain
some online capability in legacy systems during the transition to new
systems. Therefore, VA is currently evaluating several options to
restore the capability to submit an online application for pension.
Since we are still evaluating options, we do not yet have a timetable
for restoration. Additionally, as part of our transformation, we plan
to deploy the pension application within eBenefits during fiscal year
2015.
Question 2. The Department's written testimony states: ``In FY
2013, these QRTs conducted more than 145,000 in-process reviews,
preventing errors before they can impact the Veteran and providing
specialized re-training to claims processors so these errors can be
prevented in the future. QRTs made a particularly big impact on the
most common types of errors this year.''
a. How are the errors identified by Quality Review Teams (QRT)
tracked to capture the most common errors in order to better focus
employee training?
Response. All errors identified by the QRTs are entered into the
Automated Standardized Performance Elements Nationwide, the computer
program used to track performance for the quality elements.
b. How many errors were identified during the more than 145,000 in-
process reviews?
Response. A total of 16,651 errors were identified.
c. What were the three most common errors identified by the more
than 145,000 in-process reviews?
Response. The three most common types of errors identified during
the in-process reviews were:
Rating the case without requesting an exam;
Failure to request a medical opinion; and
Rating a case based on an insufficient medical exam.
d. How to these errors compare to the most common errors identified
by VA's Systematic Technical Accuracy Review and the most common
reasons for remands issued by the Board of Veterans' Appeals?
Response. The errors noted on the in-process reviews are consistent
with errors found in Systematic Technical Accuracy Reviews. The
Veterans Benefits Administration does not currently have a way to
compare these numbers to remands issued by the Board of Veterans'
Appeals.
Question 3. The Department's written testimony states, ``In 2012,
VBA found that almost 40 percent of claims rework errors across VBA
were occurring in the medical examination phase (identified as ``B2''
errors).''
a. How has training QRT coaches in Lean Six Sigma contributed to
the reduction of B2 errors?
Response. For the period of November 2011 through October 2012,
there were 624 B2 errors out of 2,274 total benefit entitlement errors
(27.4 percent). For the period of November 2012 through October 2013,
there were 344 B2 errors out of 1,687 total benefit entitlement errors
(20.4 percent). This represents a 45 percent reduction in the number of
B2 errors since the inception of QRTs in 2012. The reduction in the
number of benefit entitlement errors overall was 26 percent.
b. Has the Acceptable Clinical Evidence Initiative contributed to
the reduction of B2 errors? If so, how and what impact has it had?
Response. The Acceptable Clinical Evidence initiative is primarily
intended as a convenience for Veterans and an efficiency tool for
Veterans Health Administration clinicians. Because this is a relatively
new initiative, more data is needed to assess the true impact.
Question 4. In discussing VA's appellate process, Under Secretary
Hickey testified, ``* * * we have a standard notice of disagreement
form that will take 100 of those days immediately off that wait time
for our veterans because we have never had a mandatory standard notice
of disagreement form for an appeals before.'' What data does the
Department rely upon that supports the assertion that use of a standard
notice of disagreement form will reduce appeals processing time by 100
days?
Response. The Appeals Design Team Pilot, which ran from March 1,
2012, to March 1, 2013, found that control time was reduced to 7 days
when using the standard notice of disagreement form. Control time for
appeals processed outside of the pilot was 98 days during the same
period. This represents a reduction of 91 days in the appeals process.
Chairman Sanders. General Hickey, thank you very much for
your presentation. I am going to begin my questions with the
same question I asked in March when you were last before this
Committee, and that is, the Secretary has set a very ambitious
goal of processing claims within 125 days at 98 percent
accuracy by 2015. That is a very, very ambitious goal.
According to this week's Monday Morning Workload Report,
there were 693,857 pending claims, 57 percent or about 395,000
of which have been pending longer than the Department's goal of
125 days. These numbers clearly are better, significantly
better than the last time we met and seem to indicate that VA
is making very real progress.
My question to you is you have made progress, but you still
have a long way to go. Do the Department's claim processing
goals remain attainable? Are you, in fact, going to tell us
this morning that you are on track to achieve the Secretary's
goal of 125 days with 98 percent accuracy by 2015?
Ms. Hickey. Chairman Sanders, we are on track. Barring any
implications to our full Fiscal Year 2014 request, which we
obviously need at the expiration of the continuing resolution
in January, and barring any impact to our OIT budget, because
we are particularly focused in 2014 on the automation that adds
functionality every 12 weeks to our capability.
So, we will also require our full Fiscal Year 2014 IT
budget when the CR expires in January of this year.
Chairman Sanders. So, what you are telling us is that
everything being equal, if you get the budget that you need,
you expect to achieve the Secretary's goals?
Ms. Hickey. That is what I am telling you, Chairman
Sanders.
Chairman Sanders. General Hickey, your testimony contains
some significant statistics. It highlights a 36 percent
reduction in the backlog since March of this year, including
record numbers of claims completed in Fiscal Year 2013 and
specifically the months of August and September, an improvement
in claim level accuracy from 83 to 90 percent, and a continued
conversion of millions of pieces of paper into a digital format
suitable for use in the new electronic claims processing
system.
Are you confident that VA will continue to see this level
of production as well as continued improvement in accuracy?
Ms. Hickey. Chairman Sanders, I am confident that we will
continue to see that. I will say that we have achieved an
historical high for VBA, never achieved before, which is 1.17
million claims in a single year, never done it before, never
achieved 128,000 claims a month at the same time that our
quality was also very high and rising, never achieved a 128,000
claim month.
Even November of this year where we achieved 94,000 claims,
we have never achieved more than another month--74,000 claims.
So, we are 20,000 high in the month of November, meaning 20,000
claims more have been produced in the month of November than we
have ever done before, which is to show the demonstrated
capabilities of where we are moving.
Chairman Sanders. OK. Thank you. Let me just state that I
have got a few more questions here.
In April of this year, VA rolled out an initiative to
provide decisions on the claims that have been pending the
longest. While I appreciate VA's efforts to provide the
veterans who have been waiting the longest with decisions, I
continue to have concerns about this initiative.
The IG, the Inspector General's recent findings regarding
provisional ratings decisions at the Los Angeles Regional
Office which found a number of errors was very, very
concerning. I understand the office corrected the error by
issuing appropriate guidance to staff in June and is now in the
process of correcting any errors in claims which may have been
improperly adjudicated.
So, this IG report is very concerning to many of us. Can
you explain to this Committee any actions that have been taken
to remedy the problems identified in Los Angeles?
Ms. Hickey. Chairman, I absolutely can do that, but let me
start first by saying the IG did go back and look at these
claims later. But I will tell you the regional office knew
within 1 week of doing this guidance they had misinterpreted
the letter we sent. They were leaning in, trying to help to
really move forward. No malicious intent. They put out an
alternative guidance to the regional offices that they
themselves identified within a week that they had done wrong.
The leadership at the regional office immediately notified
Deputy Under Secretary Rubens of the issue. She immediately got
in touch with everybody across the Nation, made sure no other
guidance had been interpreted that way. It had not.
The regional office leadership immediately called not only
one all-hands meeting to make sure everybody in the regional
office knew they had made a mistake in the guidance, not the
employees; but also then conducted a second all-hands meeting
face-to-face with every employee to tell them about that and
followed up with four more letters or written correspondence to
the employees reminding them over periods of time about the
guidance on this.
Now, it is important to note that this particular regional
office had for the previous complete year made only one error
like that in the whole year before. They had cut down those B2
errors that significantly. So, this was an anomaly.
Those claims that were looked at were found during that
period of time and about the week after as it was still being
cleaned up and trickled through.
So, yes, the IG did go in and identify them later, but the
RO identified them immediately or within 1 week of making the
wrong guidance decision.
It has been resolved. We had our star accuracy team
pulling--and let me put it in context, this is 3 percent of
those half a million or 14,000 or 512,000 claims we have made
on the oldest claims initiative. We are reviewing every one of
them to make sure it did not happen again. Our star accuracy
through our compensation service is doing that.
Chairman Sanders. OK. Thank you very much.
Senator Burr.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. General, welcome to you and your team, and
thank you for your testimony. Let me ask you, as it relates to
the IG's report and the Los Angeles situation specifically, did
the LA office violate VA policy in how they implemented that
initially?
Ms. Hickey. So, Senator Burr, yes, they gave out an
alternative policy that they--they did not intend to violate
policy. They just interpreted the policy differently.
Senator Burr. So, in that short period of time before they
self-identified the misinterpretation of the memorandum, when
they went back and reviewed all the provisional decisions, it
found 470 out of 513. Can I assume that all 513 of those cases
were decided in that 1 week period and those 470 errors were
made in that 1-week period?
Ms. Hickey. So, Senator Burr, I told you that we kept
sending reminders. They had a second all-hands meeting and they
had four more follow-ups because they found some of them were
continuing to trickle out that way. So, it is about a 2-3-week
period of time before they got the errors all caught and
cleaned up, but they were actively and aggressively going after
that cleanup.
Senator Burr. Were provisional decisions included in
determining the number of claims VA is reporting it completed
during 2013?
Ms. Hickey. I am sorry, Senator, I am not understanding the
question.
Senator Burr. Were provisional decisions included in
determining the number of claims VA has completed during the
calendar year 2013?
Ms. Hickey. I am going to ask Ms. Rubens. She just told me
yes. So I will answer yes on behalf of the Deputy Under
Secretary. There were 14,000 of those claims which is 3 percent
of all of the claims we have done in the oldest claim
initiative, which was 67,000 at 2 years and older and 512,000
at 1 year and older.
Senator Burr. You highlighted 97 percent quality or
accuracy. I will use both words. Last week The American Legion
testified, ``VA's accuracy statistics from the Monday Morning
Reports are not consistent with the review of recently
adjudicated claims as conducted by The American Legion.''
According to the Legion, they reviewed 260 decisions and found
errors in 55 percent.
Also, the National Veterans Legal Service Program testified
that the current error rate is somewhere between 30 and 40
percent. In some ROs it is higher. Are they wrong?
Ms. Hickey. Senator Burr, it is an ``apples and oranges''
discussion; if I may have a moment to clarify. First of all,
let me just state for the record and for every time I talk on
this subject anywhere, we will not trade production for
quality. It is an ``and'' equation. Both must rise, which is
why it is 125 and 98.
But there is a very different way the IG and others look at
issues than the way we do. I will tell you that our process has
been validated by an external agency in----
Senator Burr. Let me ask my question again. Are they wrong?
Ms. Hickey. Senator Burr, they are right for the way they
look at it. We are right for the way we measure it, which is
statistically valid.
Senator Burr. General, they are the customer, are they not?
Ms. Hickey. Actually, the veteran, the family member, and
their survivors are my customers, senator.
Senator Burr. Yes. And these are the organizations that
represent them.
Ms. Hickey. They are, sir, and they are our partners.
Senator Burr. Should this Committee believe that there is
any VSO in America that believes that the accuracy or the
quality is at 97 percent right now?
Ms. Hickey. Senator Burr, I would ask you to ask them for
their opinions. I can not quite----
Senator Burr. They testified on it. But that is not
necessarily something that computes.
Ms. Hickey. Senator Burr, I have a statistically valid,
validated process that goes further----
Senator Burr. I asked a very simple question. Are they
wrong? I guess the answer is yes because you are saying your
statistics are different than what their review has been.
Ms. Hickey. They have a different process, Senator.
Ms. Hickey. OK. According to VA's Monday Morning Workload
Reports, there are at least 266,000 appeals that have not been
resolved. That is about 100,000 more than were pending 5 years
ago. Although appeals are not counted in VA's backlog
statistics, they represent individuals who have yet to know
what benefits they received.
Do the performance standards for regional office directors
and service center managers include how quickly and accurately
they are handling appeals?
Ms. Hickey. Senator Burr, the simple answer to your
question is yes, they do; however, I would also tell you that a
veteran does know the answer to our opinion on a claim. In many
cases they are deriving resources associated with that claim
decision already, even though they might be appealing only a
part or piece of our overall decision.
Senator Burr. So, you have a metrics that you use to
determine this?
Ms. Hickey. We absolutely have metrics on our appeals,
Senator.
Senator Burr. Would you provide that metrics for the
Committee?
Ms. Hickey. We will do that, sir.
Response to Request Arising During the Hearing by Hon. Richard Burr to
Hon. Allison A. Hickey, Under Secretary for Benefits, U.S. Department
of Veterans Affairs
Response. VBA establishes yearly performance standards to track
regional office performance. Regional Office Directors are evaluated on
the following appeals metrics:
Control time: The number of days it takes to establish an
appeal within VA systems
Pending appeals: The number of appeals in the inventory
Average days pending: The average length of time an appeal
has been pending in the inventory
Average days pending for Form 9: The average length of
time a Form 9 (formal appeal) has been pending in the inventory
Avoidable remand rate: The percent of remanded appeals
that are remanded for an action that should have been taken by the RO
prior to sending it to the Board.
As of January 31, 2014, approximately 72 percent of Veterans with
pending appeals (318,000 Veterans) are receiving benefits.
Senator Burr. On average, how long have those 266,000
appeals been pending?
Ms. Hickey. Senator, the Chairman cites some 800 days, and
so I will accept----
Senator Burr. Does VA track that?
Ms. Hickey. We do, Senator Burr.
Senator Burr. OK. At what point is an appeal considered to
be backlogged?
Ms. Hickey. We do not have a backlog number for appeals,
Senator. What I can tell you is the rate of appeals has not
changed in the last many decades.
Senator Burr. At what point does the length of an appeal
become a concern to VA?
Ms. Hickey. It is a concern of ours right this minute, sir.
I will tell you that is why we have done a Lean Six Sigma
effort on the appeals process to try to identify ways to
improve the appeals process.
In fact, we have some legislation in front of you that I
would appreciate your consideration to help the appeals
process, and I appreciate the Members of this Committee who are
supporting that.
I will also tell you we have a standard notice of
disagreement form that will take 100 of those days immediately
off that wait time for veterans because we have never had a
mandatory standard notice of disagreement form for an appeals
before, and that is, by the way, out for public comment right
now. That period closes this month, and we hope to have that as
soon as January 2014.
Senator Burr. Mr. Chairman, my last question in this round
is, how many employees are currently devoted or dedicated to
working on appeals?
Ms. Hickey. Senator Burr, I can get you the specific
number. I do not have that at my fingertips. But we have
decision review officers who are dedicated in normal hours
though they have been working overtime on compensation claims.
They have been dedicated to working appeals.
Senator Burr. Would you provide that for the Committee and
would you provide it in a way that you compare it to the
previous 2 years and how many people were dedicated to appeals?
Ms. Hickey. Senator, I would be happy to provide you what
you need.
Response to Request Arising During the Hearing by Hon. Richard Burr to
Hon. Allison A. Hickey, Under Secretary for Benefits, U.S. Department
of Veterans Affairs
Response. VA appreciates Congress' investments in VBA and the Board
of Veterans' Appeals to address appeals. While there is some variation
in staffing levels throughout the year in all of our claims processing
activities including appellate processing, VBA estimates that 899 and
902 full-time employees were dedicated to processing appeals in FY 2012
and FY 2013, respectively, including employees at the Appeals
Management Center. Currently, 895 full-time employees are processing
appeals in VBA. In the last two quarters of FY 2013, the Board hired
and began training 100 new attorneys and increased the number of
authorized Veterans Law Judges from 64 to 78. The Board currently has
628 employees processing appeals, a growth of approximately 22% in FY
2013.
Senator Burr. I thank the Chair.
Chairman Sanders. Senator Burr, thank you very much.
Senator Brown.
Senator Brown. So, why does it take 40 days longer in the
Cleveland office?
Ms. Hickey. Senator Brown, it depends on the amount of
workload that the regional office has within its inventory. So,
in some cases, we will have, as we have had in Ohio and as we
have had in other locations, major demobilizations of large
contingents of National Guard and Reserve that come back that
create sudden surges in the system.
We have had that in Ohio. The Ohio National Guard has been
participating very heavily in the current wartime environment
so there have been some surges in returns as they redeployed.
Senator Brown. But the backlog in Cleveland has been
persistent for some time. Does not the VA need to respond? Why,
if your community has sent more people to the National Guard, I
guess that is what you are saying in part, so that you happen
to live in a place where you have to wait 40 days longer is
because you live in that place?
I understand if it is a surge and it is a short-term surge,
but if it is persistent, is there not something VA should do to
move people around or assist in a way that brings that a little
more likely closer to the national average?
Ms. Hickey. Senator Brown, there it is, and we have. So,
let me just talk to you. Let me also say we had delivered
yesterday to all of you--if you do not have it, please let us
know. I will do Cleveland by example.
The inventory in Cleveland has been decreased by 47.2
percent over the last 8 months. The backlog is down by 64.5
percent. So, there is an improvement there.
Veterans in Ohio are now waiting less time for decisions.
Almost 176.2 days less than they were waiting this time last
year. Their 2-year-old claims, 99.1 percent of them are
complete. Their 1-year-old claims, 73.4 percent of those are
complete, and they have done it while increasing their quality
5 percentage points at the claim level and another 3.51 percent
at the medical issue level.
But let me tell you how we did that. We did that by all-
hands-on-deck--everybody in the Nation working on a national
workload ``queue'' model that we have done over the last 8
months which helped all veterans regardless of State borders
and have benefited from that help.
Senator Brown. OK. Thank you.
Let me tell you a story. Sean Malone is a former Marine
sergeant in New Vienna, Ohio. His claim had been pending in the
development phase for 15 months. It appears the allegedly
missing evidence that slowed his claim was already in the
system but it was not routed to whoever is evaluating his
claim.
It appears to me, and let me make sure I understand this,
that there is a discrepancy. When there is a discrepancy
between a claimant's status between paper mail and online--I
understand it seems troublesome when requested evidence is
missing or overdue.
My understanding is that there is no information provided
online or in paper form about what evidence is outstanding, and
there may be a discrepancy between the notification that there
is evidence outstanding in paper format versus online.
Is that correct, and if it is, what do you do, what do we
do to try to eliminate that discrepancy? In other words,
whether you are filing online or are filing by paper, on paper,
that one, you need to know that there is evidence missing
whether it is online or paper; second, you need to know what
specific evidence it is. It seems that we are falling short
depending on how you file on either or both of those.
Ms. Hickey. So, Senator Brown, I can absolutely both tell
you what we are doing and what help we need.
Senator Brown. OK.
Ms. Hickey. This is an easier-to-do thing in IT and in
automation: file to load that file directly onto that veteran's
eBenefits account, but that takes a fully-funded IT budget in
January when the CR expires.
IT for us is the way forward for really providing that even
higher level of service to our veterans, their family members,
and their survivors.
I will also say our VSOs who have met us online through the
stakeholder enterprise portal will start to get that kind of
information as well, but that also relies on a strong IT
budget.
Senator Brown. OK. Thank you, General.
Mr. Chairman, thank you.
Chairman Sanders. Thank you, Senator Brown.
Senator Isakson.
Senator Isakson. General Hickey, what is a B2 error?
Ms. Hickey. Senator, a B2 error is an examination error,
either an insufficient exam or an exam where we asked for the
wrong kind of exam, or a claim where we did not ask for an exam
and we should have. That is a B2 error.
It had been, singularly prior to this year, our highest
exam error, our highest error in general. But we put a big
focus on it; we asked how do we go after the biggest error we
make in the system. And I literally put it in all of our senior
leaders' performance standards last year. I said you will
reduce your B2 errors by 50 percent. Which they did.
Senator Isakson. What is it about the letter that you sent
to the Los Angeles office that they misinterpreted that caused
them to have a 91 percent error rate?
Ms. Hickey. I would like to ask, since she has the very
explicit language in the letter and had the conversation, I
would like to defer that question to Ms. Diana Rubens, the
Deputy Under Secretary for Field Operations.
Ms. Rubens. Thank you, ma'am. Thank you, Senator Isakson.
Obviously, the Los Angeles Regional Office had a problem
with B2 errors, as they interpreted the guidance that went out.
It was, ``do I have to wait for an exam that has been ordered
or do I need to order an exam. The right answer, sir, was yes
in both cases.
They misinterpreted that. Did not order exams when they
should have. Obviously as soon as they discovered they had a
spike in their B2 errors, they worked very quickly, as the
Under Secretary has indicated, to correct that.
Ms. Hickey. I will also add----
Senator Isakson. Excuse me. So, they misinterpreted and did
not order an exam to justify a provisional decision. So, the
error was they did not order the exam they should have ordered?
Is that correct?
Ms. Hickey. Senator, if I can answer that question. In many
of those cases, they did order an exam but they made the
decision before they got the exam results back. In other cases,
they did not order the exam. But there is a mix of that.
Senator Isakson. Is there a particular medical problem that
causes your adjudicators the biggest problems? Is there a
particular medical condition?
Ms. Hickey. So, we have put TBI at the top of the list for
some of those medical conditions. I will tell you that is one
of the things you do see in our IG reports because our IG is
focused on that narrow subset of claims when they go out to
look at us.
In fact, what I will tell you is in the testimony last
week, they cited those errors but what I would like to tell you
was in none of those errors cited was there at entitlement
problem to the veteran. The veterans still got what the veteran
deserved.
We made a process error where we did not get the second
signature but not an outcome error. I will say I do appreciate
it when the IG tells me we have a process where we have set a
policy and we have people not doing what we said in policy.
Though in many cases, the errors that they call us on are
not an outcome to the veteran problem. They are that we are not
doing, what we have given out as policy in the process
perspective, and that is what was reflected in the TBI
condition.
But I do appreciate when they tell me that somebody is not
following policy. That helps us clean that up.
Senator Isakson. Would it be fair to say that soft tissue
determinations are the most difficult for VA to make a final
determination on?
Ms. Hickey. I cannot state that, Senator Isakson. I will go
look to see if there is any data that sheds any light on that
for us.
Senator Isakson. Well, my personal observation is that I
think it would be because it is the most difficult assertation
to make.
One other particular question. Has Secretary Petzel
retired? I know he was getting ready to retire.
Ms. Hickey. Senator, he has not yet but we have gone
through the initial processes to begin the selection for his
replacement.
Senator Isakson. Well, I just want to make one comment for
you to deliver back to Secretary Shinseki and Mr. Petzel. We
had a hearing in Atlanta in August 2012 on the veteran suicide
problem at the Atlanta VA but also focused nationwide on the
problem--that 22 veterans a day, 8000 a year are taking their
own life--and in certain cases in the Atlanta VA, we found some
holes in the follow-up on patients who came into VA and were
followed up, were not followed up on in terms of their
connecting with their counseling and their further
appointments.
I want to thank VA for the attention they have been paying
most recently to the veteran suicide issue but please remind
them that until we get our arms around this we are going to
continue to focus like a laser beam on that problem because it
is the single biggest problem facing our veterans community
today.
Ms. Hickey. Senator Isakson, we will join you in focusing
extremely hard on this issue. Even the loss of one life due to
suicide is one too many.
Senator Isakson. Thank you very much.
Chairman Sanders. Senator Isakson, thank you very much.
Senator Blumenthal.
Senator Blumenthal. Thank you, Mr. Chairman.
I want to join Senator Isakson and commend him for raising
this issue which is linked to another problem. Increasingly
prevalent among our veteran community is the invisible wounds
of Post Traumatic Stress often linked to suicide, unfortunately
though not always.
I want to call attention to the effort that has been made
with respect to veterans of previous wars, Vietnam and others
before Iraq and Afghanistan, to qualify them for benefits
because of Post Traumatic Stress, that they may have suffered
with a condition that was unrecognized at the time, in fact,
completely undiagnosed and untreated but very much a factor for
them.
I know that there has been a settlement recently with
respect to Mr. Shepherd of Connecticut whose claim was brought
by the Yale Veteran Legal Clinic. My hope is that perhaps that
recognition can become more general with respect to other
veterans and I would like to ask for a report back, an update,
as to what the status of consideration is in VA of Post
Traumatic Stress and at the Department of Defense in terms of
what veterans of previous wars have suffered.
Let me focus, though, on the appeals issue which has been
raised here. Why does VA have no time measure for appeals? You
mentioned that you do not keep track of--maybe I misunderstood
your point there--but you do not have a metric on the time
taken for appeals.
Ms. Hickey. Senator Blumenthal, we absolutely have a metric
down to every single area on the time it takes to do the
appeals workload. What I said was we did not have a 125-days
similar goal, or stretch goal as has been mentioned before.
If I can really quickly thank you for bringing up the PTSD
issue because I would like to share on it. Our Secretary made a
very effective decision to really enable many, many more
serving members from all cohorts to have access to VA as a
result of having PTSD.
By example, in 1990 we had 49,000 service veterans on our
PTSD roles. In 2009 when the Secretary came, that number was
355,000. Today, it is over 750,000 people that we now are
paying benefits to and now have access to different forms of
health care in VA associated with PTSD.
The last thing I would just point out is, though it was not
remarked in last weeks HVAC hearing, one of the three things
that IG had been regularly looking at us for was the accuracy
of our PTSD decisions.
They have recently informed me they are not seeing
problems. So, therefore, they are going to discontinue looking.
Senator Blumenthal. I want to come back to the appeals, if
I may.
Ms. Hickey. Yes, please.
Senator Blumenthal. I stand corrected. In fact, I misspoke.
I understand that you do measure the length of time for appeals
and that you do not have the 125-day metric which would have
been the more accurate way of putting it. But what I am
troubled to find is that, unless I am wrong, the average length
of appeals has actually increased by about 7 percent since
March. Is that correct?
Ms. Hickey. Senator, I do not have that metric specifically
but what I can tell you is the rate of filing has not
increased. In fact, it has been pretty steady----
Senator Blumenthal. Well, what about the rate of decision?
Ms. Hickey. It has not changed either.
Senator Blumenthal. The average length of time?
Ms. Hickey. Let me answer you by example. For the claim
decisions we make in a year, about 11 percent of our veterans
file what we call a Notice of Disagreement. At the end of a
process that includes our regional offices, about 4 percent of
those go forward to the Board of Veterans' Appeals. At the end
of the Board of Veterans' Appeals process, about 1.2 percent or
about 12,500 claims are overturned by the board who disagree
with our decision in the claims process.
Senator Blumenthal. Is at number increasing or diminishing?
Ms. Hickey. Interestingly enough, it has held fairly
constant in the last several decades. I will tell you I do not
know what it means but this Fiscal Year 2013 is down.
Senator Blumenthal. Can you get us the number, and I
apologize for interrupting, but my time is expiring.
Ms. Hickey. I understand.
Senator Blumenthal. Could you get us the number for the
length of time that is required for resolution of appeals? I
understood it increased by 7 percent.
I would also like you to tell me why the percentage of
backlog claims in the Hartford office has increased from 57 to
58.6 percent?
Ms. Hickey. Senator, actually my data has something
different. My data shows that your inventory in Hartford is
down 9.1 percent; and your backlog is down 6.0 percent. The age
of your claims is down 59.1 days right now. Your 2-year-old
claims, you have none left in Hartford. Your 1-year-old claims,
you only have very few, 18 of them remaining. Your quality is
actually up 8.6 percentage points and your issue-based accuracy
is up to 96.05 percent, a 1.73 percentage increase.
And that is while you also have been helping in the
national workload.
Senator Blumenthal. May I ask you what date that is?
Ms. Hickey. This is as of November 30, 2013.
Senator Blumenthal. I had data as of December 7 which is
more recent data. It shows that the backlog has increased from
57 percent to 58 percent. I would like you to tell me why.
Ms. Hickey. Senator Blumenthal, we will absolutely take
that and try to explain that for you.
Senator Blumenthal. Thank you.
Ms. Hickey. You are welcome.
Chairman Sanders. Thank you, Senator Blumenthal.
Senator Boozman, are you up? Or Senator Heller, I think is
up next.
All right, Senator Heller.
Senator Heller. Thank you. Thank you very much, Mr.
Chairman and Ranking Member Burr, again for having this
hearing. In my opening statement I said, General Hickey, that I
believe that you knew this was a problem and you want to solve
this problem and you are going to do everything you can to
solve it. So, I appreciate that.
You have been giving some interesting statistics about
Hartford and Cleveland. Can you give me the Reno statistics?
Ms. Hickey. I absolutely can.
Senator Heller. Thank you.
Ms. Hickey. I will share them with you now.
Senator Heller. Thank you.
Ms. Hickey. We did have a big problem in Reno. I am pleased
that we had an opportunity to address some of that problem,
though we know we still have others to solve there.
Inventory is down by 42.1 percent. The backlog is down by
57.7 percent. The inventory, the age of the inventory they have
in their system right now today remaining is 194.9 days younger
than it was this time last year.
They have eliminated all but 13 of their 2-year-old claims
for a 94.5 percent improvement. They have eliminated 90.9
percent of all their 1-year-old claims, and they have increased
their claims space accuracy by 8.38 percent to over 92 percent,
and their medical issue accuracy has been at 95 percent and
remains at 95 percent.
Senator Heller. Thank you. I guess my concern is have you
had a chance to make it to the Reno RO. I know you have a lot
of ROs.
Ms. Hickey. I have actually been to Reno three times in 2
years and a few months.
Senator Heller. You know, we always rank it as the worst
RO. Can you give me any insight as to why that is the case and
why we continue to be one of the worst?
Ms. Hickey. Senator, this was not always a challenge for
the Reno office. In fact, they have had times where they are on
the top of the list. But they did have a growth of claims at a
time where they had some vacant positions in the workforce, and
simultaneously they had some retirements in the workforce.
Between those kinds of numbers when you are a very small
regional office, as Reno is, you see the impact pretty quickly.
Senator Heller. You cited in some of your answers and I
think a little bit in your opening statement about some of the
concerns in surges that we have. My concern is that I think it
is going to take maybe one major court decision or perhaps
another military action to get us where we were a couple of
years ago. I am not sure the structural changes are there.
We are looking at improvement, and I am glad to see that.
But I know VA has cited a number of reasons as to why we got to
where we were recently and that is obviously the changes to the
diseases associated with Agent Orange.
Obviously, court cases that have expanded VA's duties--and
frankly I think VA's own outreach and efforts--have increased
claims also.
I guess what we are trying to hear in this Committee is how
do we keep a surge from erasing perhaps all of these
improvements that we have seen in the last year?
Ms. Hickey. Thank you, Senator, for your questions; and I
will reflect back to my DOD days if I might for a moment.
When we would go into a contingency operation, we did not
go in with the resources we had. We went into that contingency
operation with a supplemental that addressed the new
requirements that that contingency brought to us that were
outside of the planning environment.
I will tell you from the way we look at it, every time we
get a new thing--you are right--I am telling you I will get to
2015 and 125 days except if I have a large perturbation of
something like we experienced in the Agent Orange environment--
260,000 claims in our inventory overnight in October 2010--that
will kill us.
So, I cannot budget for a totally unknown, unprojected,
inability-to-plan-for contingency operation that I do not know
is coming, and that I have no idea will happen in a court case.
But I do think in the future we ought to consider resources
along with some of those new requirements. I think this needs
to be addressed.
Senator Heller. Thank you.
Mr. Chairman. Senator Heller, thank you very much.
Senator Boozman.
Senator Boozman. Thank you, Mr. Chairman.
Again, we really do appreciate all your efforts. This is a
difficult situation. I know you are working very hard.
I was in the veterans' benefit office or got to visit with
them last week in the Little Rock area. You know, they have a
good story to tell. They are working very, very hard. They
mentioned the partnerships with the VSOs and our county veteran
service officers, the great job that they were doing getting
the pre-material ready so that they would have less problems.
I have a couple of things. The IG has not been real pleased
in the sense you mentioned, you know, the key to this was the
IT in the future. We struggled with that. We have had some
problems.
Can you tell us, besides rolling out new versions, what is
VA doing to remedy the issues in regard to that particular
problem?
Ms. Hickey. So, first----
Senator Boozman [continuing]. Meaning, the benefits
management system.
Ms. Hickey. Thank you, Senator, I will address that.
First, let me just thank this Committee and specifically
Senator Burr for your leadership around the fully-developed-
claims process. That is tremendously good for our veterans and,
frankly, it is tremendously good for us too and our ability to
meet the needs of our veterans. You have provided an awesome
tool to our VSOs who are just rolling in in big ways, including
your county service officers, with more and more fully-
developed claims.
So, I just want to acknowledge what you have done there in
that leadership role. Now, our veterans get a whole year of
additional benefits as a result.
Let me speak now to the VBMS system. I will tell you this
time last year when we were deploying VBMS, we did have some
latency issues. I spoke to you about that the last time. We had
about three major issues with VBMS.
We rolled in hard. We are doing what the industry calls
DevOps now which is when they put the developer with the
operator, sitting side-by-side, fixing issues as we go, so that
it works for the user and the coder knows what to code right
the first time. I believe a lot of those issues were resolved
with the January 2013 release that cleaned up a lot of those
really big issues.
Do we have things that happen every now and then? Yes. I
will tell you last week we had an access down time on VBMS, not
because of VBMS. We had another underlying infrastructure that
affected all of our systems.
So, that has been fixed, that has been resolved. It is not
the system itself. It was the underlying hardware. There was a
server somewhere that needed a new server.
But I will tell you we have it all backed up. And I will
tell you frankly on that day the ingenuity of our employees
said, ``run to ground; find every paper claim we can find in
the system that is left and start working those on the old
legacy system.'' As a result, we still had a decent amount of
production that day.
That is what I would tell you. I think VBMS is delivering
every 12 weeks new and improved functionality.
I hear that from my employees sitting at the keys, banging
it out, because I talk to them once a week on a pulse check
call for 2-3 hours. Nobody else is allowed to do it.
I talk to bargaining unit employees only who are using the
system and get to their challenges and their likes. They are
telling me if you are a rater you really like it. If you are a
VSR, there is still a little change management going on because
I have built the checklist into the system that does not allow
you to work around things and create errors. So, there is still
some adjustment from our VSR's in that respect.
Senator Boozman. Right. Tell me about what has happened to
the non-rating actions, those claims. We focused a tremendous
amount, rightly so, on the other but the dependency
adjustments, changes to clothing allowance, things like that.
What has happened to those claims?
Ms. Hickey. I am happy to do so. I am trying to get to my
page that gives me the explicit number but what I can tell you
as I am flipping pages is that, in addition to having the all-
time record-setting year for rating claims this year, I am
happy to report that for the non-rating workload we also had
the all-time historical record for those claims, doing more
than 875,000 of those non-rating pieces. That is a 16 percent
increase over last year.
Senator Boozman. You mentioned to the Senator that was
concerned about his statistics and you mentioned that his 2-
year rate had gone down significantly.
How much of that would be provisional in regard to the
category of over 2 years?
Ms. Hickey. Probably very little when we have at most
14,000 claims across the Nation out of 512,000 claims.
Senator Boozman. Thank you.
Ms. Hickey. Thank you.
Chairman Sanders. Senator Boozman, thank you very much.
General Hickey, I would be remiss, having heard your status
reports from Connecticut, Ohio, and Nevada, to not ask you
about Vermont. How are we doing in Vermont?
Ms. Hickey. Mr. Chairman, I will tell you that White River
Junction has decreased its inventory by 25 percent and has
reduced its backlog by 34 percent.
The days that your veterans are waiting for their
decisions, they have been reduced by 127 days. They are wading
into today's inventory. They have completed 18.4 percent more
claims this year than last year. They have no 2-year-old
claims, those are 100 percent complete. And they have no 1-
year-old claims, they are 100 percent complete, while they have
also increased their quality at the claim level by 15
percentage points, almost 16 full percentage points in White
River Junction, and their issue-based quality is up at 96
percent for a 4.25 percent increase.
Chairman Sanders. OK. Thank you.
Let me raise very briefly two issues. I know that Senator
Burr you have some questions you want to ask.
I want to talk a little bit about Web-based claims filing.
I want to follow up on an issue I wrote the Secretary about
last week and I appreciate both your and the Secretary's
efforts to finally move VA into an electronic claims processing
environment, something obviously long-overdue.
However, as VA continues its transition to a paperless
environment, it needs to ensure that it does not inadvertently
disadvantage certain populations of claimants. That is why I am
so concerned about an ongoing transition of web-based claims
filings from the veterans online application, VONAPP, to
eBenefits.
At present, pension claimants can no longer file online as
I understand it. This seems like a step in the wrong direction.
The veterans with service prior to 1988 and no Defense
Enrollment Eligibility Reporting System, or DEERS, identifier
must physically visit a regional office before gaining the
necessary access to file an application for disability
compensation online. You, I think, can understand how difficult
that may be for elderly veterans or those living in rural
areas.
I would very much urge--I would make the same request of
you that I made to the Secretary--first, will you restore
VONAPP filings capabilities for pension applicants until such
time as pension applications are available in eBenefits?
Ms. Hickey. Mr. Chairman, I will take this one. We own this
one. I did see your letter. We are responding to your letter
but let me just give you the elevator response here.
The VONAPP capability still exists; however, it is on our
pension page. Now, we have not, and I own this, done a very
good job about telling our veterans that is where it is.
So, we will take that for action and we will get the
message out there better and faster so those applicants can
still use some of that capability.
Second, just as I say to every veteran, I will say it again
today, I think one of the best ways to navigate our system is
to get a certified VSO, State, county, Federal, local somebody
to help. I really do value that they give it----
Chairman Sanders. I know that but not every veteran has
access.
Ms. Hickey. Absolutely, I understand that.
What I will tell you is that we have built something called
the 527EZ for our veterans. It is the counterpart to the 526EZ
online form on eBenefits. That will be loaded eventually into
eBenefits. It depends on IT dollars.
What I can also tell you that I hope will help is, and I
have seen this--I was helping a veteran myself on this--when
you go in for an eBenefits account, if you are one of those
veterans who do not show up in the DEER system, there is some
functionality on the bottom of that page. We need to do a
better job of highlighting it which I will take that for
action.
But if you click on that and say, I am having a problem, it
goes to three people at our benefits assistance service who are
dedicated to getting you in the system. We need to do a better
job about getting that word out.
Chairman Sanders. Not everybody is as familiar with IT as
you are.
Ms. Hickey. I understand, Mr. Chairman. Thank you. We will
do a better job about getting that word out across the system.
Chairman Sanders. I think my last comment is that you have
heard a lot of concern this morning about the appeals process.
We are concerned about the rise in the appellate workload
pending at the regional offices.
The average amount of time it takes to resolve an appeal
which, according to VA's performance and accountability report
was 866 days in 2012, is clearly unacceptable. So, what I want
to hear from you is how, with very specific ideas, we are going
to improve the processing of the appellate workload, and I
would very much like to hear from you within 45 days, by your
telling this Committee the actions VBA will take to improve the
processing of the appellate workload at the regional offices.
Can I have your commitment on that?
Ms. Hickey. Mr. Chairman, yes, you can and I would be happy
to deliver that.
Chairman Sanders. Thank you very much.
Senator Burr.
Senator Burr. I thank the Chairman.
General Hickey, thank you for your comments as it relates
to fully develop claims. I think the Committee has always tried
to provide anything that they thought might make the system
better. I think it is good to know that that is having an
impact.
Let me reiterate to you and your team anything, and I say
anything, that the Committee can do from a legislative
standpoint that makes the situation better we are anxious to
hear those requests. I would hate for this hearing to go on
without us not reiterating that one more time.
In your conversation with Senator Boozman as it related to
the VBMS, I have got a follow-up because last week the
Inspector General testified that claims processing staff had
complained that the VBMS system has, ``spontaneous system
shutdowns, latency issues related to slow time to develop
documents such as medical evidence for review, longer times to
review electronic evidence, mislabeled electronic evidence, and
mixing evidence from one veteran's electronic file to another
veteran's file.''
Is that an accurate depiction by the Inspector General?
Ms. Hickey. Senator Burr, I think it may be a very dated
perception by the Inspector General.
Senator Burr. Have you heard similar complaints from
employees?
Ms. Hickey. Senator, a year ago I may have heard similar
comments from employees which I listened to every single week.
We did have latency issues last year. We did have some issues
in the system. We do not have the same issues in the system.
But if I can couch that really quickly, there is some
change management that has to happen in this, as well. When you
are doing something electronic, you are standing there looking
at the screen the whole time. You forget about how much time
you had to waste when it was in paper. You had to go upstairs
two flights, go find the file in the file bank, pull the file
out of the file bank, run downstairs, go to the mail room, find
the associated mail that was hanging around in paper, bring it
back, go to the copier, go get the sticky 3M notes, write it
all down.
You sort of forget about all that logistical time that you
used to spend. So, suddenly 3-20 seconds feels like a big deal
when you are standing looking at a screen doing nothing.
Senator Burr. But you are actively involved in a weekly
conversation on the phone and you are not hearing any of this?
Ms. Hickey. I am. I hear occasionally now, I heard it a lot
last November. So, I will acknowledge that. I heard it a lot
last November, while I had the IT guys sitting there with me,
and the VBMS program management office sitting there with me,
and we are asking them literally for the note that they sent in
to the national help desk on it. We are looking at exactly the
right time and what happened and how it needed to be fixed.
Senator Burr. OK. We will follow up with the IG to see the
timeliness of what he reported in his testimony.
Ms. Hickey. Thank you, Senator.
Senator Burr. The Monday Morning Reports also reflect there
has been an increase in the number of days, the number of work
items pending in categories like correspondence, miscellaneous
determinations, and dependency adjustments and that these have
been increases that have been pending for a long time.
For example, the number of dependency adjustments increased
from 48,000 in 2010 to 228,000 today and 71 percent have been
pending more than 125 days compared to 19 percent in 2010.
Let me just be blunt. Has VA been putting off this type of
work in order to focus resources on driving down the backlog
numbers?
Ms. Hickey. As equally responsive to you, Senator Burr, no.
It is indicative by the fact that we have done an all-time
record high number of those, 875,000 of them and we are 16
percent more productive this last year over the previous year.
So no, we are not putting them off but I have good news to
tell you----
Senator Burr. So, why are these piling up?
Ms. Hickey. Because we are doing more claims, Senator. As
we do more claims, we get more dependency claims. As you all
have told me, and I accept that, as we have been slow, you have
sent more letters, rightfully so, that we need to acknowledge
and respond to at the local level so I will acknowledge that.
I am trying hard to get that mail volume down for you by
doing that claim right and well for our veterans and their
family members and survivors, I acknowledge there are a lot of
letters that have grown over this time.
But what I will tell you, we do have a really good solution
set to talk to you about, and I think non-rating workload is
perfect for automation. It does not have an adjudicative,
judgmental, non-objective rule set associated with it.
We have just built this last year, something called RVPS,
focused at dependency claims. When you file a claim online on
eBenefits today for dependents, 40 percent of them go through
in a single day and pay. This week we are loading another set
of functionality focused at our retiree population. It will
take 60 to 70 of those, flow them through in a single day--
automated, done and moving out.
I think this non-rating workload is really, really
conducive to automated IT solutions. That is where we are
focused for this next year.
Senator Burr. Ms. Rubens, VA's testimony mentions
generation three of the VBMS and that it will deploy next year
with additional capabilities including a national queue, ``will
route claims automatically based on VBA's priorities.'' I think
that is in large measure what you were just talking about,
General.
It says that the processor will place the claim with the
next best person to work based upon the skill level and
national policy.
Is VBA working on a national policy?
Ms. Rubens. Thank you, Senator Burr.
The effort behind the national work queue really is to take
things like our Priority 1 claims today--our Congressional
Medal of Honor recipients, our former POWs, the category, if
you will, of the homeless veteran, the terminal, the hardship--
that is, of course, our first priority.
Then as we continue to work the aged claims down, we
started with the over two category, then 1 year, and now we are
all on the 334-day bucket. Those are the kinds of policies that
the national work queue will help with to make sure that those
claims get routed properly, whether that is to a member of an
express lane, a core lane, or a special operations lane
depending on the nature of the claim to ensure we are, if you
will, managing that as efficiently as possible.
Senator Burr. Am I just misinterpreting the statement that?
I understand the part about routing the claim the most
appropriate place regardless of geographically where that is.
Is there an overarching national policy that exists on top of
that? Or is that routing national policy?
Ms. Hickey. Well, Senator Burr, those categories that she
just mentioned including, by the way, we put fully developed
claims in that because we want to incentivize folks to bring us
in a fully developed claim.
The national policy is just saying what is the workload we
want you to do first. So, we do not want you to go grab
something easy off the list and off the shelf just because it
is easy for you to do. We want you to do the things we say
nationally are critically important for us to do to get to 125-
98.
Senator Burr. My question earlier was, what participation
did critical stakeholders have in the development of that
national policy?
Ms. Hickey. Well, I personally engage monthly with the
executive directors of all of the VSOs and also monthly with
all of the executive directors from the military support
offices, the MSOs, as well.
We go over every single initiative we are doing, every
single strategy they do.
Senator Burr. Do they contribute to the development of that
national policy?
Ms. Hickey. They do. They give us input. They say where
they think we should do something differently. We change and
address and adapt in that environment as well. I completely ran
the old claims initiative through and by them. In fact, I think
we called a special meeting just before that.
Senator Burr. Last, if I can----
Chairman Sanders. I have got to run. Senator Burr will take
over.
I want to thank all of you for being here. It is very clear
to me that we are making significant progress. It is also clear
to me that there are a lot of problems that remain. This
Committee looks forward to working with you. Thank you.
Ms. Hickey. Thank you, Chairman.
Senator Burr [presiding]. Thank you, Mr. Chairman.
General, VBMS 6.0 is scheduled to be released this month
which includes delivering initial capabilities to the Board of
Veterans' Appeals.
As we continue to see a decrease in the number of
backlogged claims, it appears we can also expect to see the
number of appeals increase. As VBMS is deployed to the board,
it is critical that it does not hamper their ability to
adjudicate appeals in a timely fashion.
The functions and requirements of regional offices and
boards are significantly different. What steps has VBA and the
Office of Information Technology taken to tailor-make the VBMS
system to meet the need of the Board of Appeals?
Ms. Hickey. Senator, great questions. I will tell you that
from the get-go the board has been part of the requirements
development process and, frankly, has driven the requirements
development process because it is, in large part--at the end of
the day we are building that functionality out for them and
releasing them in this version.
We will add functionality just as we do every 12 weeks for
the claims side. We will add functionality over time for the
appeals side as well, but we will not do that in a vacuum.
In fact, I have to take the lead off of them for building
out of their requirements.
Senator Burr. Great. Well, let me reiterated what the
Chairman said. We are grateful to you for the job you do. Thank
you for being here today.
General, if there is one take away I would at the
conclusion of this emphasize with you, this inconsistency
between what some of the VSOs perceive of the quality debate
and what your numbers show the quality to be is something I
hope you will focus on as to how we close the gap.
Both cannot be right; both cannot be wrong. I think that it
is important that we all work off of the same metrics. I have
asked you to share some metrics with us, and I hope you will
get that here in a timely fashion.
By the same standpoint, we both know we still have got work
to do and I want your team to know that the Committee is a
willing partner to try to accelerate that in any way, shape, or
form that we can, but not to sacrifice quality. I think we are
all in agreement with that.
Ms. Hickey. We are absolutely in agreement with that,
Senator.
Senator Burr. We thank you for your time.
This hearing is adjourned.
[Whereupon, at 11:44 a.m., the Committee was adjourned.]
A P P E N D I X
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Prepared Statement of Paralyzed Veterans of America
Chairman Sanders, Ranking Member Burr, and Members of the
Committee, Paralyzed Veterans of America (PVA) would like to thank you
for the opportunity to offer our views on the VA's transformational
progress, in particular, our views on the adjudication of VA's most
complex disability claims to ensure quality, accuracy and consistency
on these complicated issues. PVA has a unique expertise in dealing with
complex claims because our members have complex disabilities as a
result of spinal cord injury or dysfunction.
The Department of Veterans Affairs (VA) has fully deployed its new
processing model for disability compensation claims, called the
Veterans Benefits Management System (VBMS), in order to reduce the
number of backlogged claims. This paperless processing model places an
emphasis on expediting claims where the supporting documentation is
fully developed by the Veteran. But the success of VBMS greatly depends
on the process design, like rules-based processes, and supportive
technologies like Special Monthly Compensation (SMC) calculators, that
undergird the system.
Unfortunately, rules-based systems treat all veterans the same and
can be flawed by imperfect rulemaking and application, invariably
leading to increased errors for these claims. This is the challenge for
a rules-based computer system; it does not have the human interaction
to fully understand the circumstances of a specific injury. The
numerous issues faced by veterans with catastrophic injuries create a
complex set of outcomes that cannot be easily reconciled by logic-based
systems that cannot appreciate nuance in disability assessments.
Calculators used in rules-based systems historically fail to compute
the right ratings for persons with multiple issues. This type of
decision analysis uses decision trees that attempt to enable the rater
to simplify and resolve complex questions. This technique, however, can
be problematic when the analysis involves highly qualitative
assessments that are reduced to binary choices.
This processing model also handles claims for veterans who have
unique circumstances, such as financial hardship, homelessness, or
serious injuries or disabilities in special ``segmented lanes.'' The
problem is the growth in the number of claims considered ``complex''
since September 11, 2001. Complex claims, according to VA, are
characterized by the number of issues per claimant filed, which has
doubled to 8.5, when compared with claims from past wartime eras. Also
of significance, of the 47,814 complex claims currently in the VA
inventory, over half are backlogged. In fairness, this number has
steadily decreased over time. But VA still takes too long to adjudicate
these claims in many cases, particularly for our members with
Amytrophic Lateral Sclerosis (ALS or Lou Gehrig's disease).
PVA has developed unique expertise in dealing with complex claims
because our membership is predicated on having one of the most complex
disabilities an individual can have: spinal cord dysfunction, whether
due to injury or disease. This can occur due to trauma, ALS, Multiple
Sclerosis (MS), and other debilitating causes, and often manifests in
both primary and secondary residual losses throughout the bodily
systems, including the often under-regarded ``invisible'' aspects of
injury like mental impairment, need for attendant care, and
helplessness. Complex claims in this regard go beyond the mere number
of issues.
Accurately rating these losses for claim purposes requires
expertise in neurology, physiatry, urology, psychiatry, and other
specialty areas. But during Compensation & Pension (C&P) examinations,
it is common to see a general practitioner authoring medical opinions
on etiology, nature and extent of dysfunction and cumulative effect of
separate yet concurrent disabilities. This is not a problem when the
examiner devotes enough time to understanding the disability and its
nuances before rendering a conclusion. However, this is not always the
case. As a result, when these opinions result in lower ratings than the
veteran should have received, the ensuing debate takes on a subjective
hue when the regulations alone do not persuade a decision reversal.
While VBA has instituted an evaluation system that assigns greater
weight to complex claims, these claims are often too esoteric for
journeyman raters, full of embedded issues and ambiguities both legal
and medical that lead to errors. Moreover, these issues do not lend
themselves exclusively to rules-based analysis without inductive,
common sense reasoning in many cases, such as reasonable doubt
provisions, which seems to have slowly disappeared from training and
guidance for new raters. Working these cases requires a combination of
experience and open-mindedness to make a correct determination. And
while a VA claim of 90 percent accuracy could be accepted, it is
completely possible that this average is due to 99 percent accuracy on
simple claims and 50 percent accuracy on complex claims. This
possibility is not very comforting to those with complex claims.
For example, in one PVA case a veteran with ALS submitted evidence
supporting a higher rating for Special Monthly Compensation at the R-2
rate from his treating physician, thus verifying his need for skilled
care in his home. Despite substantiating his need with credible medical
documentation, he had to subsequently submit to a C&P exam at the VA's
direction where the examiner concluded he did not need skilled care on
a daily basis because he had some limited movement. Not only did the
examiner improperly contemplate movement as a basis for determining
need for care, VA misapplied its own regulation on resolving doubt when
two expert opinions conflict. When common sense is applied, there is
little doubt on the question of whether a veteran with ALS, an
incurable, quickly debilitating condition with foreseeable, inevitable
consequences, needs skilled care. This case out of the San Diego VA
Regional Office illustrates what happens when a profoundly complicated
set of disabilities, a lack of expertise, subjective interpretation of
regulations, and rules that do not allow for a ``common sense
override'' option collide in a veteran's claim. In this instance, the
veteran presented enough evidence from his VA clinician, yet VA still
required a VA examination per inflexible VA guidance in such cases (see
M21-1MR Part IV, Subpart ii, Chapter 2, section H). While PVA commends
the Veterans Benefits Administration (VBA) for implementing such
initiatives as the Acceptable Clinical Evidence option, which allows a
rater to decide based on the record in lieu of a C&P exam, this has not
taken root system-wide and this needs to be disseminated nationwide.
It would also help to eliminate redundancies such as unnecessary
C&P exams that either corroborate the evidence of record or create
arbitrary bases for denying a claim. PVA has long criticized VA's
overuse of C&P examinations particularly when the evidence of record
already substantiates the claim. These exams attempt to provide a
snapshot of complex disabilities based on cursory review of the medical
history and templates, called Disability Benefits Questionnaires
(DBQs), that ask a lot of questions but not always the right ones. For
example, ``need for higher level of assistance'' is not asked on the
ALS DBQ, even though the terminal nature of the disease makes constant
need for specialized care likely in virtually every case. And with the
addition of rules-based calculators that make C&P exams a mandatory
step in many instances, these incorrect decisions are given the patina
of unassailable faultlessness. PVA is on record stating that rules-
based calculators and processing are not conducive to accurate analysis
where complex claims, as we describe them, are concerned. They can be
adequate starting points. But these claims require experienced raters
who, for example, would not conclude that a veteran who can barely
stand up due to lost ``useful'' function should be rated the same as a
veteran who can walk but with difficulty. Or that a veteran with
paraplegia cannot be considered in need of aid and attendance because
he manages his neurogenic bowel and bladder and dresses independently
thus no longer being functionally disabled.
Experienced raters, not algorithms, best factor in the nuances of
Special Monthly Compensation and areas of subjective interpretation
that can lead to an incorrect decision. For this reason, PVA has
previously asserted in testimony before the House and Senate Committees
on Veterans' Affairs that reducing the backlog through the use of
technologies cannot come at the expense of accurately rating the most
complicated claims in the inventory. This is why PVA trained its
service officers to fully develop a claim long before VA idealized the
Fully Developed Claim concept. Our service officers know what questions
to pose to an examiner, how to reconcile the medical and legal
ambiguities, and how to draw a path toward entitlement for the rater
from the time the claim is filed. But not every rater, particularly the
new ones, can or feel empowered to see past the inflexible rules and
seemingly indisputable C&P examinations enough to question or deviate
when necessary.
Perhaps that is how it has to be in the grand scheme of the entire
backlog and we understand that rules are critical to organizational
success. But the exceptions are the rule for PVA. A veteran with ALS
died in hospice while his claim was pending before a ``Special Ops''
lane coach because he needed a DBQ despite the fact that the evidence
of record supported entitlement. A utilitarian system that successfully
delivers benefits to one million veterans, but overlooks the most
vulnerable, is inconsistent with the moral obligation derived from
Lincoln's promise to those who served our country. As VA celebrates the
success in reducing the backlog through the use of new technologies and
innovative processes, more attention now needs to shift toward
developing strategies for adjudicating complex claims more timely and
accurately.
PVA believes there are several things that can be done to improve
support to veterans needing SMC:
SMC cases should be assigned only to the most experienced
raters and VA must ensure that new raters are properly trained on SMC
and its applicable regulatory doctrines.
VA needs to allow for the application of a ``common
sense'' override when rules-based processes limit or preclude necessary
subjective analysis such as reasonable doubt or the weight/credibility
of evidence, or fail to reconcile ambiguities in the medical evidence
or legal applications
It is critical that if denial of a complex claim is
predicated on a C&P exam, particularly in cases of terminal illness or
catastrophic disability, the reasons and bases must detail how the
weight of all evidence was assigned, whether reasonable doubt applied
or not, and whether the acceptable clinical evidence option was
considered in lieu of ordering a C&P exam.
VA must expand acceptable clinical evidence (VHA Directive
2012-025) for nationwide implementation.
And finally, VA must ensure the rules-based process allows
for and encourages the application of 38 CFR Sec. 3.102, which defines
``Reasonable doubt'' doctrine. Accordingly, ``When, after careful
consideration of all procurable and assembled data, a reasonable doubt
arises regarding service origin, the degree of disability, or any other
point, such doubt will be resolved in favor of the claimant. Reasonable
doubt means one which exists because of an approximate balance of
positive and negative evidence which does not satisfactorily prove or
disprove the claim.'' (Authority: 38 U.S.C. 501(a))
Historically, due to the nature of our catastrophically disabled
membership, PVA has been the subject matter expert for claims involving
multiple injuries or conditions. PVA has enjoyed the privilege of
providing VA with help in field studies and advice on processes that
best meet the unique needs of veterans with catastrophic injuries. PVA
National Service Officers have even participated in the training of VA
claims processors. This valuable service has tremendously benefited
both organizations and illustrates an important, enduring partnership.
PVA's success in claims processing is due to diligence in training our
service officers and in understanding the challenges faced by those
with the most complex of cases. VA must do the same. Data processing is
no substitute for education, training and understanding. We fear that
as VA continues to aggressively look to reduce the backlog, complex
claims may move further behind. While advances have been made in
processing theses claims for those most needing, we caution the
Committee and VA not to become too satisfied with successes that are
achieved now while some veterans are still left behind. PVA looks
forward to continuing to make VA aware of the need to keep complex
claims in the forefront and to ensure they are properly and quickly
adjudicated, particularly as they impact our most catastrophically
injured veterans.
We thank you for the opportunity to submit our views for the record
and we would be happy to answer any questions you may have for the
record.