[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
EXPLORING NATIONAL WORK QUEUE'S IMPACT ON CLAIMS PROCESSING
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
TUESDAY, FEBRUARY 14, 2017
__________
Serial No. 115-2
__________
Printed for the use of the Committee on Veterans' Affairs
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Available via the World Wide Web: http://www.fdsys.gov
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29-368 PDF WASHINGTON : 2018
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COMMITTEE ON VETERANS' AFFAIRS
DAVID P. ROE, Tennessee, Chairman
GUS M. BILIRAKIS, Florida, Vice- TIM WALZ, Minnesota, Ranking
Chairman Member
MIKE COFFMAN, Colorado MARK TAKANO, California
BRAD R. WENSTRUP, Ohio JULIA BROWNLEY, California
AMATA COLEMAN RADEWAGEN, American ANN M. KUSTER, New Hampshire
Samoa BETO O'ROURKE, Texas
MIKE BOST, Illinois KATHLEEN RICE, New York
BRUCE POLIQUIN, Maine J. LUIS CORREA, California
NEAL DUNN, Florida KILILI SABLAN, Northern Mariana
JODEY ARRINGTON, Texas Islands
JOHN RUTHERFORD, Florida ELIZABETH ESTY, Connecticut
CLAY HIGGINS, Louisiana SCOTT PETERS, California
JACK BERGMAN, Michigan
JIM BANKS, Indiana
JENNIFFER GONZALEZ-COLON, Puerto
Rico
Jon Towers, Staff Director
Ray Kelley, Democratic Staff Director
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
MIKE BOST, Illinois, Chairman
MIKE COFFMAN, Colorado ELIZABETH ESTY, Connecticut,
AMATA RADEWAGEN, America Samoa Ranking Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
JIM BANKS, Indiana KILILI SABLAN, Northern Mariana
Islands
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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Tuesday, February 14, 2017
Page
Exploring National Work Queue's Impact On Claims Processing...... 1
OPENING STATEMENTS
Honorable Mike Bost, Chairman.................................... 1
Honorable Elizabeth Esty, Ranking Member......................... 3
WITNESSES
Mr. Thomas J. Murphy, Acting Under Secretary for Benefits,
Veterans Benefits Administration, U. S. Department of Veterans
Affairs........................................................ 4
Prepared Statement........................................... 31
Accompanied by:
Mr. Willie C. Clark, Sr., Deputy Under Secretary for Field
Operations, Veterans Benefits Administration, U. S.
Department of Veterans Affairs
Mr. Ronald S. Burke, Jr., Assistant Deputy Under Secretary
for Field Operations, National Work Queue, Veterans
Benefits Administration, U. S. Department of Veterans
Affairs
Mr. Zachary Hearn, Deputy Director, Veterans Affairs and
Rehabilitation Division, The American Legion................... 17
Prepared Statement........................................... 33
Mr. Ryan Gallucci, Deputy Director, National Veterans Service,
Veterans of Foreign Wars....................................... 19
Prepared Statement........................................... 35
Ms. Kelsey Yoon, Director, Veterans Benefits, Vietnam Veterans of
America........................................................ 20
Prepared Statement........................................... 39
EXPLORING NATIONAL WORK QUEUE'S IMPACT ON CLAIMS PROCESSING
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Tuesday, February 14, 2017
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Disability Assistance
and Memorial Affairs,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 10:31 a.m., in
Room 334, Cannon House Office Building, Hon. Mike Bost
[Chairman of the Subcommittee] presiding.
Present: Representatives Bost, Coffman, Bergman, Esty, and
Brownley.
Also Present: Representative Walz.
OPENING STATEMENT OF MIKE BOST, CHAIRMAN
Mr. Bost. Good morning, and welcome everyone. This
oversight hearing of the Subcommittee on Disability Assistance
and Memorial Affairs will now come to order. I first want to
take a moment to welcome the Subcommittee Members, especially
those who are new to Congress and new to the Committee, and
also those who are returning.
It is my privilege to have been asked to be Chairman of the
Subcommittee and I am grateful to Chairman Roe for the
opportunity. I want to explain that although I look forward to
working with Ms. Elizabeth Esty from Connecticut as our new
Ranking Member, under Committee rules Ms. Julia Brownley is
still the Subcommittee's acting Ranking Member. And my
understanding is that the Full Committee will schedule a
business meeting to formalize the Subcommittee assignment and
our new Subcommittee Ranking Members soon. We also want to make
sure that we know that we have been joined by the Ranking
Member Mr. Tim Walz. I want to thank him for being here. I want
to ask unanimous consent for the Ranking Member Walz, for
Representatives Esty and Sablan be allowed to sit at the dais
and ask questions. I also want to ask unanimous consent that
Ms. Esty be permitted to serve as Ranking Member for this
hearing pending her ratification before the Full Committee.
Hearing no objections, so ordered.
By way of a short introduction this is my second term in
Congress and on this Subcommittee. I am a father of three and a
grandfather of 11, and before coming to Congress I worked in a
small business, in a trucking business, and my wife and I own a
beauty salon. I was a firefighter and a state representative
for over 20 years in the State of Illinois. I am also honored
to say that my family has a tradition of service. I am not only
a Marine, I am a Marine and a father of a Marine. I am enlisted
and he is an officer, so it kind of makes for unique
conversation around our home.
The House Veterans' Affairs Committee is known for working
in a bipartisan manner to ensure that the Department of
Veterans Affairs provides our former military members with the
best service possible. Our Nation's heroes deserve no less.
This Subcommittee specifically addresses how to best provide
for the needs of veterans who have medical conditions relating
to their service. We also work together to ensure that veterans
who have passed away are treated with dignity and respect. I
look forward to continuing this tradition and working with Ms.
Esty and the Members of the Subcommittee on the issues that are
critically important to the veterans and our Nation as a whole.
That said, the first DAMA Subcommittee oversight hearing of
the 115th Congress will focus on how national work queue, or
the NWQ, has impacted the department's ability to process
disability claims. Before the NWQ, the VA's practice was to
process a veteran's claim at the regional office in the State
where the veteran lived. The challenge was that some regional
offices had large backlogs and veterans in those states were
often left in limbo even if the regional offices in other
states would have been able to process the claims faster
because of not being so busy.
The NWQ is supposed to increase effectiveness and
efficiency by automatically assigning the claim to the regional
office with the most capacity. On its face this is a common
sense idea. The NWQ allows the VA to distribute its workload
evenly across the Nation to reduce waiting times for veterans
who file claims for benefits. However, there are some concerns
about whether the NWQ is actually performing as it should.
Unfortunately the VA claims backlogs have increased from about
76,000 backlogged claims on May 2, 2016 before the NWQ was
fully implemented to now almost, well as of February 4th
101,000. One has to question whether the distribution of work
throughout the NWQ is in fact more effective.
Rather than assigning a claim to a specific employee to
work the entire claim, the NWQ breaks up the claim into
individual tasks, such as scheduling a disability exam. After
one claim processor reviews a file and completes an action, the
NWQ will likely assign another claim processor for the next
step. The second claim processor then also has to become
familiar with the file to determine whether additional action
is needed for the VA to make a decision. It does not make sense
to me on how having multiple claim processors completely review
the same file can possibly save time.
We will hear from our second panel as well, and it is
comprised of the veterans service organizations. The VSOs used
to receive an advance copy of the rating decision before it was
sent to the veteran. This practice gave the VSOs 48 hours to
review a proposed decision and raise objections before the
decision was finalized. But now that the NWQ has been deployed
VSOs complain that they no longer have a chance to review a
decision and try to resolve errors before any incorrect
decision is sent to the veteran. I hope the VA will explain
what steps it is taking to work with the VSOs to ensure the VA
decisions are accurate.
I am also looking forward to learning more about how the VA
intends to monitor employees' production and quality standards
now that the NWQ has been implemented. I also hope that the VA
will tell us more about what the department intends to do to
tackle the current backlog of appeals and non-rating claims and
how it plans to leverage NWQ to do so.
Again, I want to thank the witnesses for being here today.
And with that I want to call on the distinguished Ranking
Member Ms. Esty for her opening statement.
OPENING STATEMENT OF ELIZABETH ESTY, CHAIRMAN
Ms. Esty. Thank you very much, Mr. Chairman. I appreciate
your warm welcome and I am delighted to be joining the
Committee. I am happy to be here today as the Ranking Member
designate of the Subcommittee on Disability Assistance and
Memorial Affairs and I am looking forward to working with all
of you to ensure that the veterans that we are honored to
represent are receiving all the quality of care and the rapid
service that they and their families deserve.
A bit about my background, I am in my third term in
Congress. I am the daughter of a Navy man, daughter-in-law of
Air Force, and have niece and nephew who are Army. So we need a
Marine. You know, we are working on getting a Marine in the
next generation. My district in the fifth district of
Connecticut is the proud home to over 40,000 veterans, a long
service tradition. In my office it is always issue number one,
two, or three for constituent services. We have made it a core
part of our mission. I hire veterans proudly in my office and I
am committed to ensuring that everyone who has served this
country is served in turn by all those of us who enjoy the
freedoms that they secured.
I want to thank Mr. Murphy and the deputies from the VA for
appearing today to help us understand how the national work
queue program is functioning now that it has been rolled out in
all 56 regional offices. Now in speaking with Connecticut
veterans it is my impression that the claims backlog in our
region has been reduced significantly and I want to
congratulate you on that progress. However I also want to
understand some of the issues and delays that do remain and I
look forward to working with you to improve the claims process
going forward.
To the VSO witnesses here today and to the thousands of VSO
sponsored veterans service representatives in every part of the
country, you are providing reassuring and dedicated assistance
to veterans as they navigate the disability process and
pensions process. I thank you for your commitment to veterans
and to making sure that it gets done right.
I know we are all here for the same purpose. We want to
enjoy the benefits and speed and accuracy of automation. But we
need to ensure that that personal touch is ensured and that our
veterans are treated with that care, and the VSOs have provided
that. So I am looking forward to hearing from you today how we
get the best of both worlds, the high tech and the high touch.
I know that is our objective and we are not there yet, I think
we are in agreement. But I do know that everyone is committed
to getting us where we need to be. And so I will be looking
forward to the testimony and working together collaboratively
to get us here. I see we have been joined by the current
ranking, my good friend, colleague, and classmate, Julia
Brownley, and my work buddy from the gym, I see Mr. Coffman has
also arrived.
Mr. Bost. Thank you, Ms. Esty. Okay, I ask that all Members
waive their opening remarks as per this Committee's custom. Now
I would like to welcome our first of two panels. Thank you for
taking the time to be here today. Our first witness is Mr.
Thomas Murphy, who is the Acting Under Secretary for Benefits.
He is accompanied this morning by Mr. Willie Clark, the Deputy
Under Secretary for Field Operations; and Mr. Ronald Burke, the
Assistant Deputy Under Secretary for Field Operations. I want
to remind the witnesses that your completed written statement
will be entered into the hearing record. And Mr. Murphy, you
are now recognized for five minutes.
STATEMENT OF THOMAS MURPHY
Mr. Murphy. Good morning, Chairman Bost, Ranking Member
Esty, and Members of the Committee. Thank you for the
opportunity to discuss the implementation and progress related
to VA's national work queue.
The NWQ is a workload prioritization and distribution tool
designed to match claims assignment capabilities with VA
capacity regardless of geographical boundaries. This tool
provides the means necessary to ensure veterans receive a more
timely decision on their disability claim. The NWQ uses
sophisticated system capabilities to uniformly prioritize VA's
electronic claim inventory and allow for the collection of
enhanced data on processing efficiencies, areas for quality
improvement, and issues impacting processing capabilities. This
new environment allows VA the flexibility to move claims to
locations around the country that have the capacity to take the
next action on the claim while maintaining the flexibility at
each facility to assign work to the right person.
One of the principal fundamentals of NWQ is to ensure that
veterans are served equally, regardless of where they live. A
review of claims from 2015 shows that in many instances the
timeliness of a decision was significantly impacted based
solely on the state in which a veteran lived. Some were
receiving decisions in 106 days while others took more than 213
days, nearly double the time. This variance demonstrates the
inefficiency of the RO-based claims model, where each regional
office receives claims based on geography rather than what
their capacity is to complete work. When NWQ was rolled out the
average days pending for veterans disability compensation
claims was 94 days. This was reduced to 85 days by the end of
fiscal year 2017, a ten percent reduction.
VA breaks the claims process down into cycles. Upon receipt
of a claim, VA develops for evidence. The inventory of claims
awaiting initial review was reduced from approximately 56,000
to 18,000 as of the end of January, 2017. The average number of
days to a first development action has dropped from almost 25
days to less than ten in 2017.
Following the initial development actions VA prepares a
rating decision to identify each disability, its severity, and
its relationship to military service. The amount of time claims
were awaiting a rating decision has dropped from about 29 days
to 16 days.
Once a rating decision is complete, VA prepares award
notification for the veteran as appropriate. The award time has
dropped from eight days to four, and the authorization time
from four days to less than two.
VA continues to work toward reducing the number of claims
pending over 125 days. While we acknowledge that some claims
will take more than that, we have made significant improvements
over the past two fiscal years. In 2015 VA completed 45 percent
of its claims within the 125 days. As of January, 2017, 66
percent were completed within the 125-day standard.
NWQ is a component of VBMS and one feature that is built
into the NWQ allows VA to measure the amount of rework in our
system, which has never been possible before. It allows any VA
employee in the process to stop the line to correct a
deficiency, a process similar to that used in industry to
ensure high quality. Because of this feature we are now able to
measure process defects based on feedback from our employees.
As a result, approximately 6,500 claims reviewed in 2017 have
been returned to an earlier stage for correction.
Systematically tracking these errors enabled us to tailor
training and increase accountability in the claims process.
With an endeavor this large VA spent a lot of time and
resources on a measured change management approach to NWQ
implementation. Our efforts included briefing various
stakeholders, training employees, publications of an NWQ
playbook, and a myriad of calls and briefings with each
regional office. VA utilized new data to revise director and
employee level performance metrics and created standard reports
used to improve workload management and effectively manage
resources. Additionally VA is bringing together more than 1,100
supervisors and managers for continued training on tools and
best practices.
While VA is acclimating to this new work environment we
took the feedback we received to heart and have implemented
methods to increase the amount of local work assigned to
regional offices. While we acknowledge that there is more work
to be done it is important to recognize that these efforts have
and continue to generate positive and significant results for
veterans.
Mr. Chairman, this concludes my statement. I would be
pleased to answer any questions you or Members of the Committee
may have.
[The prepared statement of Thomas Murphy appears in the
Appendix]
Mr. Bost. Thank you, Mr. Murphy. And I would like to yield
myself five minutes for questions, if I may. On May 2, 2016
before the NWQ was fully implemented there were almost 76,000
backlogged claims. Yet last week there were more than 100,000
backlogged claims. The increase is about 33 percent over nine
months. Is it the VA's assertion that the NWQ is improving
effectiveness and efficiency in processing claims?
Mr. Murphy. Yes sir, it is. And the reason is we now for
the first time have the ability to work, look at the right next
claim that needs to be worked. So today the work that we are
sending out, we are sending out every claim that is available
to be worked in the backlog every single day, and then we are
working back as early as claims that are less than 90 days old
being pushed out to regional offices. So we are leveraging the
ability to see the exact case that needs to be done and sending
it out to a regional office for action at just the right time.
Mr. Bost. Okay. So but from what we can see of our numbers,
what specific factors are contributing to that increase that we
see over that nine-month period? I mean, that is a concern.
Naturally all of us are wanting to see them processed as quick
as possible. But to see that increase, what would the agency
say the reasons for that are?
Mr. Murphy. I am going to ask Mr. Clark to jump in on this.
He runs our Field Operations Division.
Mr. Bost. Okay.
Mr. Clark. Good morning.
Mr. Bost. Good morning.
Mr. Clark. And thank you, Mr. Chairman. It certainly is my
pleasure to respond this morning. The first thing I would like
to say is our receipts have gone up since last year. One of the
things that we know that as we get more efficient, more
veterans are aware of benefits that are available to them. They
come in and they submit more claims. Additionally we are taking
a more balanced approach to the work that we are doing. One of
the things that we have done in the past and we did great work
in getting the backlog down in past years, but we focused
probably too much on the backlog. And we have this old saying
in the VBA that if you work only the backlog then all you work
is the backlog. So we have improved in our appeals. We have
improved in answering phones. We had a blocked call rate of 60
percent, almost 60 percent a couple of years ago. And now we
are at zero percent blocked calls. Non-rating, those types of
claims, dependency claims, we have claims drill pay, we are
working those claims. So what we are doing, is taking a more
balanced approach. But we do understand and we do keep an eye
on our backlog to make sure that we do not have veterans
waiting too long.
Mr. Bost. Yes, that would be the concern. And another part
of my question is what plans do you have to, though we should
not work off the backlog, I agree with you on that, that alone,
but that is still a major factor that we can use to say, okay,
how quick are we getting these processed through? And when you
see the buildup it is concerning to us. And I am sure it is
concerning to everyone involved when you see that continue to
pile up. So what intention, you know, what do we see out there
that we can do to speed the process up?
Mr. Murphy. I will take that one, sir. About six months ago
I took a look at where we were spending our money in terms of
overtime dollars, and the number of people that we had, and the
number of vacancies that we carried. And as a result I went out
to our top 25 percent performing offices and increased their
authorized end strength. If you look at my authorized end
strength today, the day the hiring freeze was put on we had 250
people above authorized head count. And the reason for that is
I took very high cost overtime dollars and I converted it into
full time labor. When those people start into the process it
takes about a year to get a VSR up to standard and ready to
work; it takes 18 months to two years for RVSRs. My point is
this. Six months ago I started that action and in a few more
months you are going to see VSRs in place doing better
processing and you are going to see more raters in place within
the next six months.
Mr. Bost. All right. The other concern that I have right
quick, and I am going to finish this up fairly quickly because
my time is running out, but the concern we have of rather than
one person dealing with a particular claim and having it handed
off over and over and over again quite often can cause a lot of
confusion. And my concern, do you have that same concern that
maybe one person is not focusing on one claim? And as it passes
through multiple hands, do you see a problem with that?
Mr. Murphy. I am going to ask Ron to talk about this one.
And yes, I had that concern. But the changes we have made over
the last several years, it is much smaller than it was.
Mr. Burke. Mr. Chairman, thank you for that question and
semper fi. To talk about that topic specifically, we have
learned, this is still a relatively new initiative that we are
still learning from. We absolutely wanted to make sure that our
claims assignment and our claims distribution was matched to
where capacity was. As we get more data from the NWQ system we
are learning better ways to optimize this. As such, one of the
things that we are going to be doing in our next VBMS release
is actually maximizing the amount of work that goes to the home
station. We believe that will do several things. Number one, it
will most likely assign a claim back to an employee that has
seen it before. And as one of two former VSOs on this panel,
and one of three veterans, we also received that stakeholder
feedback from our VSOs, that the inability to have that work
assigned to the home station more frequently was impacting them
as well. We have heard that feedback. We have created an
enhancement request that will actually in our March release
allow us to almost reverse the percentage of claims being
assigned to the same station. We believe that will help with
the issue of multi-looks that you raise, sir.
Mr. Bost. Okay. And just real quickly if you can, because I
know my time has expired, but how many on average would you
think employees handle one claim as it processes through under
the existing system?
Mr. Burke. Well what I can tell you, sir, is right now that
the amount of work per each step in the process that is being
assigned to the home station is about 30 to 35 percent of each
daily distribution. We believe with the March release that will
allow us to increase it above 50 percent, maybe as high as mid-
fifties. That will significantly reduce the amount of instances
where multiple employees are seeing the same--
Mr. Bost. Do you have an average of how many people touch
the claims as they go through?
Mr. Burke. Sir, it really depends on the claim itself. So I
do not have a number--
Mr. Bost. Three? Six? Eight?
Mr. Burke [continued]. Normally in any environment it takes
five to six touches for a claim from initial development to
completion--
Mr. Bost. Okay.
Mr. Burke [continued]. --to begin with.
Mr. Bost. We would like to add that number to the record,
then. And I would like to turn it over to the Ranking Member
Ms. Esty.
Ms. Esty. Thank you, Mr. Chairman. And thank you all for
your service and your commitment to work together with us to
serve veterans better.
I actually want to pick up where the Chairman left off on
this issue of ownership. I have a lot of manufacturing
companies in my district. I am a third generation manufacturing
daughter and granddaughter. This issue about continuous
improvement and lean does depend on ownership. The VSOs have
been that ownership. I think we need to figure out how we
ensure that we are reducing the number of touches where
appropriate. Now obviously you may have very complex claims and
those are going to require and should go to the people best
able to do that. There are specialized claims that we know are
much more fairly and rapidly processed in specialized settings.
I think we do need to work for the typical claim to keep it
closer to home, keep the VSOs engaged, and reduce the number of
touches that we need to have. So if you could talk a little bit
about in addition you just spoke, Mr. Burke, about in March
issuing a directive to reduce that number so more of it stays
in the ROs. But what else are you hearing in terms of feedback
that will not just reduce the time but improve the accuracy and
the engagement which is going to be necessary to keep our
veterans feeling served as well as being served?
Mr. Burke. Yes, ma'am. Thank you for that question. Let me
first start with the latest part of your question about
quality. One of the things we are also building into our
process is an automated, we are calling it the diagnostic tool.
This is purely based to improve and focus on the quality of our
claims processing at all steps. This is an automated feature
that will run in the background as an employee is processing a
claim. And before that claim moves to the next step that
employee will have the opportunity to hit a diagnostic check
and it is designed to catch some of the major trends that we
see now with stepped steps or confusion in the claims process.
So we believe that that will help.
I am actually leading an endeavor to, we bring 1,100, and
we are still in this process, bringing 1,100 of our first line
supervisors and division chiefs physically into a location for
training. The purpose of this training is to talk about our
trends, the new reports, and we have created a standard suite
of reports so that our supervisors can lead better, they can
see issues with the claims process. But on the issue of
ownership what we are stressing the importance of is that we
have got to treat this national work unit environment like an
ecosystem, meaning every action that we take on a veteran's
claim has a subsequent reaction. And what we are stressing is
that we want pride and ownership from our employees in every
action they take on a veteran's claim, whether it is the entire
claim or pieces of the claim.
But to that point, what we see is a valued need to route
more work to the local station than what we have been doing
since implementation. And again, that feedback not only comes
from our employees but from our VSO partners and other
stakeholders.
Ms. Esty. Thank you. I want to follow up also on the
question of how we are having, you know, the backlog going up.
We are in a freeze right now. So let us be clear, you know, the
Committee has been told that VBA has 760 vacancies. Mr. Murphy,
you talked about how you are redirecting money to more
appropriately try to cover but you still have those vacancies.
And it is our understanding those will not be exempted from the
hiring ban at this point. When you are looking at the final
rule establishing eight new presumptive diseases associated
with exposure to contaminated water at Camp Lejeune, that is
going in effect March 14th. How are we going to keep up? You
are going to see intake go up. Obviously we are going to. And
we have vacancies. Can you talk a little bit about what do you
expect to happen to the backlog when those cases come online?
Mr. Murphy. We are overstaffed at this time. So the intent
right up front six months ago was we are going to hire ahead
because we always had 1,000 positions vacant. And what happened
was we authorized the strength out to 100 percent to each
regional office. An RO would wait for a vacancy, then they
would start the fill process, four to five months later a
person would show up and begin training. So what I did is I
bumped up an additional end strength across the Nation, told
everybody you can hire up to 105 percent, and they followed the
normal process which took them to the 100 percent mark, part
one.
Part two was at the same time I spent $130 million, real
round numbers, on overtime. Overtime is very expensive. Why not
convert some of that to permanent employees and keep the rest
of it for overtime, and use the overtime money for crises and
surges that we have? So in addition to the extra five percent,
we converted 50 percent of the overtime dollars to FTE and put
the authorization out to the field to hire those individuals.
Those folks now are working through our challenge process
today. So again, I am 250 bodies over my authorized end
strength from the presidential budget for 2017 and we lose
approximately 40 people a pay period right now. So I can ride
it out and still be above end strength for the next three
months plus, depending on how the attrition rate goes before we
are impacted by not having people on board. Then the next
measure would be we start moving people out of non-direct labor
positions into direct labor positions. That is the most
important part is the delivery of service, not to have an extra
person at a headquarters. So we do have a hiring freeze in
place. And we also have a movement freeze in place where we are
now allowing people to move out of our direct labor positions
and be promoted into other positions, which leaves me trying to
figure out how to deliver services.
Ms. Esty. Thank you. I see my time has expired but I
appreciate your explanation. Thank you all very much.
Mr. Bost. General Bergman, you are recognized for five
minutes.
Mr. Bergman. Thank you, Mr. Chairman. And it is an honor to
be with all of you this morning and thank you for all of your
service, both in uniform and now in a suit. The State of
Michigan has a very high percentage of veterans comparatively
speaking, and the first district that I represent has double
the percentage of veterans as the other districts in Michigan,
and largely rural, so we have some unique challenges. And as
far as the questions I am going to ask, I am not going to ask
person specific. So whoever would choose to respond, please
feel free. What are the problems with NWQ that delayed its
implementation?
Mr. Burke. Thank you, sir, for that question. As with any
release in VBMS, we go through a rigorous testing process. When
we initially intended to deploy the national work queue before
May, we had completed that testing. But testing in a testing
environment is different than actually putting it in a
production environment. Testing passed, everything was
successful. As we went to go into the production environment we
intended to do so over the course of a weekend. We noticed that
the actual production job, the job of pulling in claims
electronically, prioritizing them electronically, and also
staging the distribution to 56 regional offices, took too long.
Our goal is to always have claims deposited at a regional
office and in an employee's queue before they start their day.
We do not want any idle time. We do not want any employee
waiting for work to do. As such, it is important that our
entire distribution job starts at around midnight and needs to
finish by around 4:00 in the morning. We noticed that the job
was taking too long and we decided to pause, go back and retool
and reconfigure until that processing time could be reduced.
That was the issue, sir, that caused the initial delay, because
we did not want to put ourselves in a position where employees
did not have work available to them at the start of their work
day.
Mr. Bergman. So in other words, you feel that by the
testing, the testing that failed, if you will, and what you
implemented as you saw the timeframe work, so have the problems
with that been resolved to your satisfaction?
Mr. Burke. Yes, sir. That actually was resolved and was the
key feature, if you will, that allowed us to actually
successfully deploy to all stations in May of `16.
Mr. Bergman. So a little OJT there?
Mr. Burke. Yes, sir.
Mr. Bergman. All right. And OJL, as in on the job learning.
Mr. Burke. Yes, sir.
Mr. Bergman. NWQ is fused with the VBMS system. We were
told that this system needs to be either replaced or updated.
Does NWQ have the ability to be compatible with new or updated
benefits management systems going forward?
Mr. Burke. So what I would say, sir, is when we designed
and developed and built the national work queue, it was under
the auspice of VBMS. It is certainly owned and operated as a
different entity. I have a full team of administrators that
operate the national work queue. But we do go through the VBMS
process for any enhancements, any new features, etcetera. And
so right now we are connected solely to VBMS and we are
dependent on VBMS right now to operate.
Mr. Bergman. So is that a yes or no? If VBMS is replaced
with something, would we start from square one with NWQ again?
Mr. Burke. I certainly think, sir, that if we were to do
that we would be dependent on integration, proper integration,
with a new system. And I am sure as part of our doing that that
would be incorporated. We would have to integrate NWQ with
anything if we replaced VBMS.
Mr. Bergman. Okay. Why did it take one year after NWQ's
implementation for the VA to impose new employee productivity
and accuracy standards? Why did it take a year?
Mr. Murphy. I will start with that one and then I will
probably have Willie jump in. We went with a partial roll out,
started the roll out in May timeframe. We did not complete it
until the summertime. And then we ran it from summer up until
two months ago and looked at live production data using 100
percent of the population to develop standards which we
presented to the union in February, which go live on March 1st.
So in the past we have always used sampling of a couple of
people. But this time we used 100 percent of the population
across the Nation over a period of six months. So arguing or
discussing or negotiating what individuals can produce is no
longer an issue in the setting of standards because we are
using what you actually produced. So all of the discussions we
have had in years past about what should the number be are
gone. It is very simply we used a statistical process, we laid
it out, we used standard deviation, this is the performance
standard, next step. So it took a little longer. It took us six
months of live process. But now we have numbers that are
actually right and based on what our individuals are producing
on a daily basis.
Mr. Bergman. Thank you. I see my time is up, Mr. Chairman.
Mr. Bost. Mr. Walz? Ms. Brownley? Ms. Brownley, you are
recognized for five minutes.
Ms. Brownley. Thank you, Mr. Chairman. And I too want to
add my voice and thank all of you for your service to our
country and your service to our veterans as well. So I think,
Mr. Murphy, you in your opening comments talked about there is
still more work to be done, and there has already been
discussions on where improvements can be made. Are there other
areas that we have not discussed so far that you are looking at
to improve the system?
Mr. Murphy. I am going to hit this at a very high level and
then give it to Ron in about 20 seconds. And the answer is we
are getting so much data out of every little transaction right
now, we are still trying to figure out how to use some of the
data. An example of that is what we did with RVSRs and
performance standards and how we used statistics to lay it out
and say, wow, look at what is here. Ron runs this every day. He
sees all these numbers. I spend a lot of time in his office
digging. He may be able to put a little more clarity on that.
Mr. Burke. Thank you. Yes, ma'am. A couple of things that
we are doing right now, we have, while very short-lived in this
environment, we have started to gather a ton of data that was
not available before. One of the things that we are really
keenly focusing on is the reduction of our rework. We now have
an automated process that allows us to catch anytime an
employee indicates that a claim has to move backwards in the
process. To that end we are also able to discern whether that
backwards movement could have been avoided or whether it was
unavoidable. This allows us to take a look at improving
training, improving gaps in policy or procedure, and really
tailoring our training to meet the trends that we see.
So one of the biggest things that this environment has
allowed us to do by the implementation of an automated deferral
process is to capture the daily data that we did not have
before. And that really speaks more towards making sure that we
have the right performance standards, making sure that we have
the right training tools, making sure that as we create new
reports for supervisors to use to manage both workload and for
employee performance that we bring together, get on the same
page, and actually provide some consistency that was not there
prior to NWQ.
Ms. Brownley. Thank you for that. In terms of vacancies,
Mr. Murphy, did I understand you to say that we are losing, we
lose approximately 40 employees per pay period?
Mr. Murphy. That is correct. Prior to the hiring freeze we
lost between 55 and 61 per period. There was a good percentage
of those that were moving to other agencies. If other agencies
are no longer hiring then that number will be reduced down to
about 40 that would actually leave the Federal government.
Ms. Brownley. And so are there additional reasons why you
are losing that many people per pay period? Is it advancement
or is it they are leaving?
Mr. Murphy. No, these are, this is not turnover, moving to
another job. These are people that are leaving the agency. And
that is actually a very low number. I come from a sector where
we ran 20 to 25 percent, 28 percent. We typically run in the
low single digits percentage as an agency. So 40 people with a
population base of 22,000, that is just normal retirements and
taking another opportunity someplace else.
Ms. Brownley. When back in 2013, I think, when we were
first discussing this transition, and I really do believe that
this transition has been, is certainly there are plenty of
indications that it has been successful. And so I want to, you
know, congratulate you all in that endeavor. Obviously, I
agree. There is still more work to be done here. But one of the
things that we talked about was the fact that for those people
who are doing this processing that what could emerge from this
system are people who are experts across the country in
particular type of claim. And perhaps with that expertise that
that in and of itself would streamline and make the system more
efficient. Is that happening? Do you see that kind of trend?
Mr. Murphy. We have the data to give us that kind of trend.
We have not taken any action on it yet to actually physically
realign. And the concept you are talking about is let us say
St. Paul, Minnesota becomes experts at PTSD. So we route PTSD
cases to that rating board because they are really good at that
product. We do that at a lower level now with IDES claims, we
do it with Camp Lejeune contaminated claims, and there are
several others where we do those in pockets to concentrate low
density things. But what you are talking about is a center of
excellence where we would concentrate high volumes of work. We
have the data to do it now but it is not an action that we have
taken yet. It is certainly on the table for future
improvements.
Ms. Brownley. So I think in this week's Monday morning
workload report, the Los Angeles regional office, which serves
my veterans, the average days pending is 105 while it is only
85 days in Fargo, North Dakota. I presume that VBA is tracking
these numbers. But are you adding more people and resources in
areas where you know they are going to, and you can anticipate
that there are going to be more claims?
Mr. Clark. Yes ma'am, we are. And I recall going back I
oversaw the western region, of which L.A. was one of those
offices, and there was a point in time that the average claim
was well over six months.
Ms. Brownley. Yes.
Mr. Clark. So one of the things that we did previously, we
would pick cases up physically and move them via UPS or we
would just shift cases and now with NWQ this is why we are able
to do things electronically. So on the aggregate our average
days pending and average days to complete have lowered
significantly. We do keep track of all of our claims that are
pending. And one of the great things about NWQ is we can just
target or send that work to places where we have capacity. So
sometimes proportionately maybe certain claims or certain
amount of radiation claims or what have you, may be pending at
a particular RO. But on the aggregate we send cases where we
have a need to send work and where there is capacity. That is
where it goes. And it goes everyday at 4:00 a.m. Mr. Burke and
his team of folks moves that work around.
Ms. Brownley. Thank you very much. I apologize. I yield
back, Mr. Chairman.
Mr. Bost. Thank you, Ms. Brownley. And Mr. Coffman is
recognized for five minutes.
Mr. Coffman. Thank you, Mr. Chairman. And Mr. Murphy, out
of the claims backlog what percentage would you just say are
PTSD only?
Mr. Murphy. I would have to go back and get you a detailed
number on that one. I would not even want to venture a guess.
But what I can give you some idea--
Mr. Coffman. Is it the largest, let me just ask you this--
Mr. Murphy [continued]. No sir--
Mr. Coffman [continued]. --is it the largest right now in
terms of pending claims?
Mr. Murphy. It would be, in isolation no, but in
combination with others, yes.
Mr. Coffman. Okay. And then what are some of the, I am
concerned that we are not focused enough on our combat veterans
in terms of the claims process. What amount, can you give, and
again just a very rough break down, of what I would call age
related issues in terms of the claims process? Whether it is
hearing loss that is not necessarily associated in terms of
being, you know, around explosions or around aviation assets
and things like that?
Mr. Murphy. I can tell you what we have in terms of the top
five to seven conditions, the ones we see most frequently. So
PTSD is very high on the list. Traumatic Brain Injury is fairly
high on the list. But even much more common than that is
tinnitus, hearing loss, and then musculoskeletal injuries for
knees, ankles, back. Those are the most frequently occurring
conditions.
Mr. Coffman. Okay. What, and how well, tell me about your
shift to a more electronic system? And I know that is somewhat
controversial. I think that some of the VSOs have fought to
retain a paper system because it is simply easier for some of
the veterans that are not sophisticated in terms of electronic
communications to be able to utilize. But where are we at in
that whole process?
Mr. Murphy. We do not work cases in paper any longer. There
is just, there is a very small fraction of a percentage that is
actually existing in paper still. It is all a paperless
environment. In fact, a week ago we completely unpapered
Philadelphia. There is no paper left in Philadelphia. We have a
team in St. Petersburg right now and in a couple of weeks there
will be no paper left in that office. And then we are moving
across the Nation. At the end of the fiscal year we will have
most of them done. By the end of next fiscal year we will be
completely done with paper in all regional offices.
Mr. Coffman. And am I clear you are down to about 18,000,
is it 18,000 in the claims backlog? What is the claims backlog
now?
Mr. Murphy. The claims backlog as of this morning is give
or take 100 or 200 claims 99,000.
Mr. Coffman. Oh, how much?
Mr. Murphy. 99,000.
Mr. Coffman. 99,000?
Mr. Murphy. Yes, sir.
Mr. Coffman. Okay. And tell me where you want to be a year
from now?
Mr. Murphy. I would like it to be as close to zero as we
can get.
Mr. Coffman. Okay.
Mr. Murphy. I mean, that is probably, I do not know,
25,000, 30,000, 40,000 depending on the work flow. There are
some cases that are never going to be under 125 days because
you are just shortchanging the veteran to go away and do that.
Radiation claims, long research history--
Mr. Coffman. Sure.
Mr. Murphy [continued]. --and exposures, etcetera. And it
is just an injustice to the veteran to force it into 125-day
process. So to say we are going to get to zero, that is just
not going to happen. It is not the right thing to do. But it is
certainly not, it can be smaller. Any system you have got, no
matter how good it is, can get better, ours included.
Mr. Coffman. Have we just been pushing these claims to the
appeals process? In other words, that we are just kicking them
upstairs by trying to expedite and shrink the volume in terms
of the claims backlog?
Mr. Murphy. No, sir. That just creates more problems for me
to deal with later. We actually have stopped the growth in
inventory in the appeals process. We were on an eight-year
upward slog, steady growth. In the last three months we have
actually turned it and started reducing in the appeals process.
And the reason for that is, five months ago I locked in the
appeals people and just made them an isolated, nobody could
work on anything other than appeals if you were assigned to
appeals. So that dedicated workforce, 1,495 people, work only
appeals on their prime time, overtime, any time that they are
working. And then that focus, along with just a little bit
extra pressure and a few modifications and changing process,
has resulted in us flattening and starting to bring down the
overall number of appeals.
Now inside of that the number of appeals sitting at the
Board of Veterans Appeals is growing because we are producing
them faster and pushing them across to the Board of Veterans
Appeals which leads us into the legislation pending in Congress
now about appeals reform.
Mr. Coffman. Okay. Mr. Chairman, I yield back.
Mr. Bost. Mr. Walz, you are recognized.
Mr. Walz. Thank you, Mr. Chairman. I appreciate it. And Mr.
Murphy, a special thank you to you. I know you have been there
throughout this whole process, as the number of claims have
reached its peak, and as we addressed it. You adjusted fire and
fired for effect and reduced them as we were hoping would
happen. I for one am grateful that you chose not to take your
talents and go elsewhere where you could probably be paid more
and have less headaches. I do appreciate that.
Mr. Murphy. It is a work of passion.
Mr. Walz. It is a passion and it has been apparent. And I
think that is what our veterans deserve. It is what they
demand. And I think it is important for us because I have
watched you come here on numerous occasions through this but
always with a goal on that end of working together. So I am
appreciative of that.
Just a couple of things, and this is coming from our VSOs
who I know you are a good partner with. And I truly know and I
would like to say a special thank you to your employees, too. I
literally watched those folks out at the St. Paul RO burn the
midnight oil during numerous occasions during the backlog and
they brokered in a lot to them. I agree with you on this. We
were paying a lot of money for overtime that needed to be done
but I think to smooth this and keep things going that does make
more sense. So when we talk about accountability, we talk about
hiring freezes, we do need to talk about in the long run hiring
and retaining really good people can not only do the right
thing for veterans, it can save us money in the long run. So I
appreciate you on that.
Just a couple. Our VSOs expressed concerns that their rep
cannot find that contact information when they need to reach
out to a VA employee in the RO to correct an error. How does
that happen? Or how do you respond to them when they say that?
Mr. Murphy. I am going to give the details to Mr. Burke on
that one.
Mr. Walz. Okay.
Mr. Burke. Sir, thank you. We have tried to ensure no
degradation of service or relationship between our VSOs at the
local regional office and the staff there. To that end we are
all learning from this process. It has posed some challenges.
We are adjusting fire, as you referenced. But we have
designated personnel in each regional office, the same regional
office that the VSO resides in, that have been put on kind of
an ancillary role, if you will, that they can serve as a direct
liaison between that VSO and that office. No matter where the
claim is, they have a peer that they reach out to, to kind of
facilitate those discussions. Admittedly it is a process that
we need to improve on. I think we are really, really good at it
in some areas, and in some we get a reminder from our partners
once in a while that it may not be working as intended. So we
want to make sure that there is that local flavor, both the
high technology, high touch type thing that was referenced
earlier today. But certainly an area that we will continue to
improve on.
Mr. Walz. No, I appreciate that. And I certainly appreciate
the spirit that you are approaching it. These are your partners
and if they are good at it, they know. And that is just a force
multiplier for all of us. So I am grateful for that.
And I will just end with one, and you brought it up, Mr.
Murphy, with Camp Lejeune and we are coming up on the 14th.
Having, and I said this in hearings at the time, I continue to
say it. A lot of the backlog came out of the Nehmer claims
which I am glad that it was approved, that we were there. And I
feel like I added a lot of work for you by pushing that through
and when the Secretary added it, I understand that. And I do
not think we gave you the necessary up front resources once the
Nehmer claims went through that that did cause that. That is
not an excuse, but it is certainly a reason. Are we going to be
okay that we are not going to see that? I know the numbers are
probably far less but not certain of that, and how that will be
handled?
Mr. Murphy. Are we talking specifically about the Camp
Lejeune cases?
Mr. Walz. Yes, on the 14th, am I right, on March 14th--
Mr. Murphy. The date is coming up here shortly. The
difference, what got us bogged down last time was the
uniqueness of the Nehmer claim and the fact that you had to go
back and do a page one review literally decades old. That does
not apply in this case. This is claims that have filed since we
did the notice, plus, so it is point forward. It is a
completely different type of work. And the fact that we put the
presumptive in there, yes, it is certainly going to bring more
volume in the door. But the presumptive helps speed the process
up because--
Mr. Walz. Are you going to funnel those through one RO? Or
are you going to just kind of handle it in the normal process?
Mr. Murphy. Ideally, we want to keep them in the one RO
because we have that center of excellence we were talking about
just a moment ago. If they cannot handle the volume we are
going to have to train another and expand it. So we will have
to keep a very close eye on that.
Mr. Walz. So, but you are not, you are concerned, you are
focusing on it, you are there, you are ready to adjust to it.
But you do not anticipate anything near the disruption that the
Nehmer claims caused?
Mr. Murphy. No, nothing at all like that. The Nehmer claim
was a tidal wave and this is going to be a real small one by
comparison.
Mr. Walz. Great. Well, again, I am grateful. I appreciate
you being here as always. And it is about service to those
veterans and it is clear, as I said, of watching you over the
last half decade or so that you have done what you were
expected to do. I yield back.
Mr. Murphy. Thank you, sir.
Mr. Bost. We want to thank you for your testimony. We
appreciate you being here today. If we have any follow up
questions we will be sending those your way and thank you for
being here and for what you do. And hopefully we can improve on
this but we need to move on to our next panel.
Mr. Murphy. Thank you, sir.
Mr. Bost. If that is all right? And if the second panel
then will come to the witness table?
I want to say welcome to everyone and thank you for coming
today. Our second panel includes Mr. Zachary Hearn, the
Department Director of Claims of the Veterans Affairs and
Rehabilitation Division of the American Legion; Ms. Kelsey
Yoon, the Director of Veterans Benefits of the Vietnam Veterans
of America; and Mr. Ryan Gallucci, the Duty Director of the
National Veterans Services for the Veterans of Foreign Wars.
And first we will hear from Mr. Hearn of the American Legion.
And Mr. Hearn, you are now recognized for five minutes.
STATEMENT OF ZACHARY HEARN
Mr. Hearn. Thank you. American Legion Past National
Commander Ronald Conley initiated a series of visits to VA
facilities in 2003. After these visits the American Legion
declared VA a System Worth Saving. Over 13 years have passed
since that declaration but this truth remains. The American
Legion knows the VA is a system worth saving.
Good morning Chairman Bost, Ranking Member Esty, and
Members of the Subcommittee. On behalf of the National
Commander Charles E. Schmidt and the 2.2 million members of the
American Legion, we welcome this opportunity to speak with you
regarding the impact of the national work queue upon the
adjudication of claims. VA Secretary David Shulkin echoed the
American Legion's sentiments regarding the value and place VA
has with our Nation's veterans during his confirmation hearing.
We fervently believe VA is a system worth saving. We need VA to
listen to us. We need VA to work with us to ensure management's
success.
The American Legion has over 3,200 accredited
representatives with representatives in each of VA's regional
offices. This level of assistance and expertise by these
individuals led the American Legion to represent over 804,000
veterans in the last fiscal year. Many view or representatives
as advocates for veterans. The fact is we could be a fleet of
advocates for VA. But they not only need to listen to us but
also implement what we are asking.
NWQ and Veterans Benefits Management System are
inextricably intertwined. NWQ is not viable without a properly
function VBMS that allows for the fullest advocacy efforts by
veterans service officers. VA began briefing the American
Legion in 2015 regarding NWQ. It was designed to maximize its
workforce and adjudicate claims in a more expeditious manner
through routing cases to VA regional offices based upon
availability. The American Legion recognized the potential for
the program, however concerns existed and continue to exist
regarding its implementation and execution.
The advocacy and adjudication of claims has historically
been a local venture. A veteran residing in a given area of
jurisdiction could reasonably expect the claim to be developed
and adjudicated at the local VA regional office. Much of claims
advocacy is built on internal relationships with regional
offices and NWQ would sever some of those relationships. VA
advised that the local regional office would serve as the first
filter where the claims would be adjudicated. However, in the
case of some regional offices this has proven untrue. The St.
Paul regional office has reduced the adjudication of claims of
veterans from Minnesota from 99 percent to 30 percent over the
course of two years.
A major complaint received by our service officers is the
fact that VBMS does not have the ability to alert local
representatives of claims development. VA has established a 48-
hour window to review claims. However, VA has occasionally
removed a case prior to the close of the allotted period of
time. The American Legion hosts a department service officer
school biannually and during the last school in July, 2016
service officers working in regional offices were asked to
raise their hands. They were asked to lower their hands if they
had come across a case that had been removed from adjudication
review prior to the 48-hour window. Not one hand was raised.
These concerns have been raised to VA, yet the problem
continues to linger.
Even if the local representative where the claim was
adjudicated was notified it would be of little assistance. The
local representative is not familiar with the veteran and the
associated claim. Moreover many of our service officers are
employed by state agencies funded by local tax dollars. Those
employees are working to assist veterans in their given state.
It is unfair for them to also assist veterans residing outside
of their jurisdiction.
The American Legion regularly conducts quality review
visits. Last year we met with VA employees to discuss the
impact of NWQ. Some welcomed NWQ, however others had concerns.
These concerns listed from line employees to senior leadership.
The VA employees noted that a disconnect exists. A developer at
one location may not develop the claim to the degree required
at another location, causing added delays in the process.
Another complaint involved NWQ pulling back cases into the
virtual queue and redistributing them after a substantial
amount of development occurred at the original regional office.
Despite completing the bulk of the work the original regional
office does not receive the credit. One senior leader stated
that it is disheartening to have an employee complete the bulk
of the work while another location gets the credit. In a
production environment this could hurt morale.
VA has taken great strides in reducing its backlog of
claims from its peak in March of 2013. The implementation of
fully developed claims and VBMS have allowed VA to enter the
21st Century. VA needs to truly believe that veterans service
organization are stakeholders and a fleet of advocates that
could be used to improve their product. They simply need to
listen.
Chairman Bost, Ranking Member Esty, again on behalf of the
Nation's largest veterans service organization we thank you for
the opportunity to speak about this issue this morning and I
will be happy to answer any questions that you may have. Thank
you.
[The prepared statement of Zachary Hearn appears in the
Appendix]
Mr. Bost. Thank you, Mr. Hearn. And Mr. Gallucci, you are
recognized for five minutes.
STATEMENT OF RYAN GALLUCCI
Mr. Gallucci. Thank you. Chairman Bost, Ranking Member
Esty, and Members of the Subcommittee, on behalf of the 1.7
million members of the VFW and our Auxiliary, I want to thank
you for the opportunity to testify on this issue. I know in my
written testimony the situation with national work queue looks
dire. But I want to clarify that the VFW supports NWQ and we
believe that this is how VA can maximize efficiency using every
resource at its disposal to deliver consistent, quality,
accurate, and timely benefits to veterans.
NWQ shows significant promise in meeting this objective.
Our concerns rest with the final step in the process for
veterans represented by accredited VSOs like the VFW.
Unfortunately, this issue is so complex that we saw prudent to
articulate every way that we believe this affects VA's ability
to deliver a quality product to veterans and our ability as
advocates to provide quality customer service to our veteran
clients. By a decades old policy, VA allows VSOs 48 hours to
perform a final quality review on proposed rating decisions
allowing us to identify any potential errors and get them
corrected before the decision is sent to the veteran. VSOs see
this as a chance to ensure VA gets it right the first time.
Based on VFW's analysis, we find errors in about one out of
every ten claims that we process, and we can usually work with
VA to fix them before the veteran ever knows. This is not only
a positive for the veterans we serve but also a benefit to VA.
On a grand scale, if VSOs can perform quality reviews on all
ratings and explain the context of the decision to our
veterans, we cut down on appeals and build confidence in the VA
system. On a local scale, VSOs learn to become stronger
advocates, VA staff learn to be more meticulous raters, and
veterans receive consistent, accurate, and timely benefit
decisions.
While this policy has been supported by VA management, the
VFW has seen examples where personnel in regional offices,
potentially reacting to pressures on productivity, will
finalize rating decisions before the 48 hours expire. We have
also seen NWQ pull ratings out of regional offices while they
are still in the 48 hours, meaning our representatives lost
optics on them while the clock ticks. We have also seen
brokered work stations immediately finalize rating decisions
for work under their jurisdiction if no VSO representative is
present in the office in accordance with VA's Manual M21-1.
This makes it impossible for the VSO representatives who
originated claims to track their work regardless of the
filtering workarounds offered by VA through VBMS. We appreciate
that VA has offered this work around, like zip code filtering,
and a potential new field to filter by station of origination.
But as we articulated in our written remarks, these workarounds
do not solve the overall problem.
Our objective as accredited VSOs is to serve as the public
facing advocate to help veterans navigate the complex VA
benefit system. As such we align our resources to either the
needs of the community as we see in North Dakota, or the
special mission of the VA regional office like we see in
Winston-Salem and Salt Lake City with the pre-discharge claims
program. When VFW takes power of attorney for a veteran client
the veteran is placing his or her trust in the VFW to serve as
a quality advocate in not just filing for VA benefits but also
ensuring any awarded benefit is accurate. Our representatives
in the field must build trust and credibility with not only
their clients but also their local VA colleagues to properly
advocate for veterans. When our advocates do not have the
opportunity to review the work for their clients, everybody
suffers. At first it may look good that VA was able to send the
rating decision to the veteran more quickly, but this is no
good if the decision is inaccurate. As our representative in
North Dakota said, we have lost local advocacy.
The VFW's ask on NWQ is really three-fold. First, return
proposed rating decisions to the station of origination so that
the VSO representative who is most familiar with the claim can
conduct a proper review. Second, lock the 48-hour clock in VBMS
so that VA staff cannot pull back the rating decision before
the VSO clicks reviewed or the 48 hours lapses. Third, allow
VSOs to mark proposed ratings as queried in VBMS so that VA can
track potential errors and hold staff accountable for
addressing any potential errors. The VFW believes that the
infrastructure already exists to execute these three steps in
NWQ and is a more simple solution than building a new filtering
option in VBMS.
The VFW and our partner VSOs have asked for these solutions
since NWQ was first proposed. Unfortunately, we worry that
these requests have been pushed aside in favor of VA's internal
priorities. Now we understand that VA has its objectives to
improve its work product, but our purpose today is to
demonstrate to this Subcommittee and to VA that the VSO's
priorities are also VA's priorities. The VFW believes in NWQ
and we want to work with VA and the Subcommittee to make this
successful. If VA can execute these deliverables, we believe
that we will have advanced in our mission of providing timely,
quality, and consistent benefits to our veterans.
Chairman Bost, Ranking Member Esty, this concludes my
testimony and I am happy to answer any questions you may have.
[The prepared statement of Ryan Gallucci appears in the
Appendix]
Mr. Bost. Thank you, Mr. Gallucci. And Ms. Yoon, we want to
recognize you. Just for purposes Boston--Bost-- that is what,
the name is--no, that is okay. Everybody does it. I am just
going to go ahead and get it so everyone knows. Ms. Yoon?
STATEMENT OF KELSEY YOON
Ms. Yoon. Thank you. Good morning, Chairman Bost, Ranking
Member Esty, and other representatives of this distinguished
Subcommittee. Thank you for inviting VVA to testify today about
the national work queue's impact on claims processing.
VVA is supportive of using technology to create a better
claims system, however not at the expense of accuracy,
transparency, or a pro-veteran claims process. Currently it is
easier to track a FedEx package than a VA claim. VA has
sidelined VSOs during the development and implementation of the
national work queue by not prioritizing the crucial role of
service representatives. Consequently the pro-veteran claims
process has suffered to the detriment of the veteran. VVA is
left concluding that VA's only interest is to use the national
work queue as a tool to eliminate the backlog and nothing else.
VVA strongly opposes the expansion of the national work
queue to appeals and non-rating claims until at a minimum the
three recommendations we put forth in our written statement are
fully implemented. I would like to take this time to briefly
discuss three barriers to the claims process that VVA currently
experiences as a direct result of the national work queue.
First VSOs are unable to track accurately its claims that
need review before a final decision is issued in VBMS. For
example, if our service officer files a claim in Seattle,
Washington that claim could be kicked to Atlanta. That service
officer is unable to track that claim to its rating decision
being issued. VVA believes that when our service officers are
unable to review the claims they filed VA is depriving veterans
of their right to competent representation.
For more than two years VVA has stressed the importance of
a station of origin search filter in VBMS but VA continues to
give this request zero priority. Adding a station of origin
search feature will permit service officers who filed the claim
to be able to competently assist their veterans through the
entire claims process regardless of if the claim is adjudicated
in another station.
The second barrier, assuming the VSO is able to identify
which RO the claim has been sent to, VA has yet to provide
accurate contact information for each station. Often the email
addresses provided are incorrect or outdated, leaving the VSOs
unsure of who to contact at the out of state station. This is
extremely important when we are trying to contact during the
48-hour review period.
And finally the third barrier, even if we have the correct
contact information for the station, it is difficult to receive
at timely response, if we get one at all. Since implementation
of the national work queue service representatives are further
distanced from the claims process and in some instances blocked
out entirely. Consequently VVA has been forced to appeal more
claims than previously, which adds to the backlog. All of these
problems did not happen pre-national work queue because service
representatives developed working relationships with VA raters
at their home station and all claims were adjudicated in the
same state where the veteran resides.
The veterans benefits claims process is a unique
adjudicatory system. It seeks to be non-adversarial and pro-
veteran. VVA urges VA to prioritize the recommendations made in
our written statement so that veterans and their
representatives are again included in the claims process.
Thank you for this opportunity for VVA to share our
thoughts on this issue and I am happy to answer any questions.
[The prepared statement of Kelsey Yoon appears in the
Appendix]
Mr. Bost. Thank you. And I will go with the first five
minutes of questioning. Mr. Hearn, our number of backlog claims
when we started this project was about 76,000, now it is about
101,000, or thereabouts. Do you think the NWQ actually has
improved the situation or not?
Mr. Hearn. And the American Legion has noted that there has
been an increase in the backlog of claims during this period of
time. As far as if it contributes to the backlog, I could not
say. But it certainly has not been, you know, it certainly has
not decreased it as the numbers would bear.
Mr. Bost. What suggestions would you have to improve this?
Mr. Hearn. I think, again, a lot of it when we go through
and we look at how these claims are being adjudicated or they
are being processed in the system, there is a lot of back and
forth that is going on between the VSR and the raters. In one
location if you take a, let us just say you take a poor
performing regional office and that developer meets, you know,
cuts the mustard as far as they are concerned there. Then it
goes to a rater at a higher performing area where they would
not accept that as being the necessarily development. So then
the rater ends up kicking it back. And so here this starts
slowing this process down. Had this been in the same office the
person could have walked across the service center and said,
hey, look, you need to fix this? We need to schedule an exam.
We need to do this level of development. So I think that some
of this, some of these issues are probably contributing to a
certain extent.
Mr. Bost. Okay. Then that kind of leads to this question.
Right now I just asked you specifically what input you would
have through your organization. So I am going to ask this of
all three members. Has the VA asked each one of you what they
could do to improve this, and what has been the response?
Mr. Hearn. They have asked. We have offered solutions. And
we continue to ask for those same, you know, those same asks
keep getting asked over and over and over again over the last
six months to a year, I would say.
Mr. Bost. Mr. Gallucci?
Mr. Gallucci. So thank you, Mr. Chairman. I do want to
reiterate what Mr. Hearn said. Because that was really an
overarching theme in our testimony as well. Is that we
persistently make requests of VA on things that they need to
prioritize in changing their business processes, but we do not
know where those stand on their list of overall priorities.
What we are trying to convey to VA is that our priorities are
not just the priorities of VVA, the American Legion, and VFW.
They are the priorities of the veterans that we serve. And we
provide that customer facing advocacy. These men and women walk
into our offices, call our offices, they develop interpersonal
relationships with our representatives. And so we need to be
able to provide that personal advocacy for them.
It also becomes a problem, not to get on too much of a
tangent, but where these different processes happen in
different offices we have heard anecdotally that sometimes
there is duplicate work happening. So they may order an exam
that was not necessarily needed, or as Mr. Hearn said it will
get kicked back into the process someplace that it did not need
to be. So I think my recommendations would likely echo the
American Legion's in improving the business flow in those
regional offices. It is good to hear that VA wants about 50
percent of the work to stay at the original office of
jurisdiction. But again, I do not know if that is going to
solve their problem. Automation has the potential to improve
this process.
Mr. Bost. Ms. Yoon?
Ms. Yoon. Yes, I would also concur with Mr. Hearn and Mr.
Gallucci. VVA has continually, as I stated earlier, for years
been working with the VA to try to explain what we need in
order to assist the claims process. And like I mentioned,
because of our inability to properly track and assist
claims with the original service officer who worked on it, it
forces us to appeal claims that we would not have had to appeal
pre-national work queue, thereby adding to the backlog. So I
would just emphasize that, again, as Mr. Gallucci said, we are
all on the same team. We are trying to do the same thing and
achieve a final and just decision at the lowest level possible.
And the recommendations that we put forth seek to achieve that.
Mr. Bost. Well let me tell you, I think this Committee is
on the same team with you as well. In your original testimony
you actually brought up the fact that quite often the
communications come with the wrong email address?
Ms. Yoon. Yes. So was earlier stated, the VA has provided a
contact person or a generic mailbox at each RO. So if we do not
know who to contact at that RO, if we do not know the rater, we
are instructed to email this email address. It is either a
personal email address, a name, someone's name at va.gov, or it
is a corporate email box. Those email addresses are often wrong
and we will send the email to the person we are supposed to
contact and the response, if we get a response which is common
to not get a response, you are contacting the wrong person, I
do not do this. So the request that we have made in our written
statement is that VA publish on its website an updated list. We
certainly understand that there is turnover and the person of
contact should switch. But they need to be able to provide that
realtime updated to service organizations so we know who to
contact at that point.
Mr. Bost. Thank you. I would turn it over to the Ranking
Member.
Ms. Esty. Thank you, Mr. Chairman. And I take it, I think
we are all on the same page and I think it is going to be up to
us in Congress to prioritize these issues to better serve
veterans. You know, part of what we have done now there has
been a lot of focus on backlog so the VA is focusing on
backlog. Well if we want these quality measures and
transparency and accountability in place, we need to prioritize
that and we need to be pushing VA. And that is why we are
thanking you for your partnership with us in ensuring that that
happens. And again, I have no doubt the VA wants this too. But
if it is not prioritized from somebody who can assist or not
and shine some light or not, it may not happen.
Is a 50 percent goal enough? You know, we heard from Mr.
Murphy that their goal is now to return 50 percent, or leave 50
percent in the RO. Any thoughts from the three of you on
whether we think that is an appropriate goal?
Mr. Gallucci. First of all, thank you, Ranking Member Esty
for that question. And I have some thoughts on that. You may
have seen in my written testimony that in talking about some of
these solutions to the VFW they really just seem like work
around. I mean, an objective to have 50 percent of the work in
the station of origination sounds good. It is better than 30
percent, do not get me wrong. Having a station of origination
work filter in VBMS is also better. But I do not think it is a
100 percent solution for some of the reasons that I pointed out
before.
The manual allows VA to immediately promulgate decisions if
we have no VSO representative in that office. And just for a
little bit of background, the way that our resources are
aligned at the VFW sometimes we do have turnover in those
offices. The example that I had in my written testimony was a
regional office that had a vacancy at the moment. We out of our
headquarters were tracking a claimant that we were working with
in the hopes of reviewing that rating decision when it was
posted for the 48-hour review period. That 48-hour review
period never happened because that regional office was
immediately promulgating decisions. So even if we had the
station of origination filter, it would not have helped us in
the situation with that veteran. And what is interesting about
this specific case is that VA failed to evaluate one of the
claimed conditions on the claim and it resulted in an
additional eight-month ordeal for that veteran and for the VFW
to try to resolve that issue. So the SOO filter to us, the 50
percent station of origination work, does not really solve the
problem. That is why I mean, really, our testimony was more of
a wish list. If we had an optimal situation what we would want
is to return it to the SOO, freeze the clock so they cannot
pull it back into the national work queue, and then allow us to
mark ratings as queried in VBMS as opposed to just reviewed or
lapsed.
Ms. Esty. Thank you. That is really helpful. And we have
had some of those cases in my office. And I am thinking we
managed to crack the code in immigration cases, a coding system
that they used that allowed us to actually track, Ms. Yoon, as
you mentioned, who is handling the case, how has it been coded.
And I think that might be something we want to explore in more
detail. Could we do better coding so you would know who was in
charge if it gets sent someplace else? So if that person is no
longer there, you would be able to go and look at that RO site
and see, wait a minute, 132 is not there. So we are going to
have to find out who is now taking over those cases. So it
seems to me that the technology ought to be able to offer us
that transparency and accountability. But we may need to push
VA to say you need to prioritize encoding this in a way that
allows us to actually know who we contact and get realtime
information. So I do not know if you have done any work on
that. But maybe, Mr. Chairman, we could look at utilizing
exactly this technology to say, okay, if we are going to use it
let us use it for the benefit of veterans. Not just reduce the
backlog, but be able to still have that accountability and that
touch. So as we move forward I would welcome your thoughts on
whether we can use the technology to help solve this problem.
Mr. Gallucci. Ranking Member Esty, if you do not mind I
would like to follow up on that. Because there was another
point about the list of points of contact that Kelsey made in
the regional offices. This becomes problematic because it takes
reporting of errors outside of that digital environment. So
VBMS is a digital claims management environment, how VA is
tracking all of their work. And Mr. Murphy articulated that
they have been able to glean so much data from there that they
have been able to identify break downs in the business process
and hold individual employees accountable. For a rating review
if we find errors there is no such opportunity. By having to
send a separate email to a random VA staffer or a corporate
inbox, there is not accountability for reporting those errors.
And then when we click either reviewed or let the 48 hours
lapse so it would say expired there is then no accountability
on the back end for VSOs that, hey look, we found an error. It
was not addressed within a timely manner. So that is one of the
reasons we are asking to mark them as queried in VBMS. Thank
you.
Ms. Esty. That would be great if we could follow up and
figure out how to embed that. I think that is a really
important point and if we are getting incomplete data, I will
not say inaccurate, incomplete data about the error rate, that
is really important that we figure out how to code that. And I
think we should continue on with that. Thank you very much.
Mr. Bost. General Bergman?
Mr. Bergman. First of all, thanks to all of you for all you
do for the veterans. The veterans service organizations vary in
their scope, vary in some of the populations that they serve. I
am hoping for all of you that you are working very hard to
encourage those veterans to, whether they join the American
Legion, the VFW, the Vietnam Veterans of America, we need to
know what is going on amongst the youngsters, if you will, that
have served so honorably.
To all of you, the VA has claimed that the NWQ would
improve on rating consistency and accuracy. From the
perspective of you, the VSOs, have you noticed improvement in
these areas?
Mr. Hearn. The American Legion conducts quality review
visits every year. We just did return from San Juan last week.
And to their credit, to San Juan's credit, they are vastly
improved from where they were 18 to 24 months ago. However, I
would still contend, and the American Legion has historically
differed in what the definition of error is with VA, and a
static appellate rate or even a declining appellate rate is
just strictly that. That does not mean that your quality is
better. It just means more or less people have appealed.
Typically 20 to 30 percent error rate is what we see. And
what we determine as error rate is that there was something
done wrong in the development process, not just strictly a yes
or no, grant or denial of the benefits. So I would not say, it
certainly is not the panacea to VA's problems as far as the
error rate is concerned.
Mr. Gallucci. General Bergman, thank you for that question.
I think it is tough to draw a conclusion at this point.
National work queue is a very new business process, which is
one of the reasons we wanted to get out in front of this and
really appreciate this opportunity to address the Subcommittee
on this issue today. Is because from the VFW's perspective we
think that moving work efficiently in a digital space around VA
has potential to improve accuracy. I do not think we are there
yet. Based on our own review of rating decisions we find about
one in ten have an error. That has been fairly consistent, but
a few months ago we were almost getting up closer to two in ten
where we were identifying errors.
Whether that is because of national work queue it is tough
to say because looking at VA's self-reported data on claims
based accuracy that is a number that has also been decreasing
over the past few years. But when they break down claims based
accuracy it also is directly correlated to the number of issues
that a veteran claims. So one to two issues per claim are more
likely to be accurate than if you have seven to 12 issues in
that claim. And that becomes a problem because veterans are
claiming more issues as they become more aware of the benefits
to which they are entitled. I think at least from the VFW's
perspective it is too soon to tell. But one of our objectives
here today is to get in front of it and make sure that VA can
provide us with the tools we need to hold them accountable for
any errors and fix them before they go out the door.
Ms. Yoon. Yes, I do not have too much to add. I concur with
both statements already made. I would just emphasize that I do
agree that it is too early to determine whether it is helping.
I do agree that there is potential with the additional data
that we can get from the national work queue. However, I would
also emphasize that if we continue along the pathway that we
are without including the VSOs into the process of the claims
process, then it could potentially have very negative impacts
on the accuracy of decisions.
Mr. Bergman. Thank you. Mr. Hearn, how do you feel VA
handled the rollout of NWQ?
Mr. Hearn. It is kind of interesting because when VA was
testifying the statement had been made that they are just now
hearing that cases are not being adjudicated at the local level
as much as the VSOs would like. But when it was rolled out we
were initially told that essentially the right of first refusal
was the local regional office. When you drop from 90-plus
percent down to 30 percent in Minnesota, that is not even
hitting a majority. And so that has been a big problem with us.
And it is not only that but it is also dealing with the issues
of claims development, not getting our mail, not getting, I
mean that is the mantra we are hearing from our service
officers is we want our mail back. In other words, if something
happens along the claims process as far as development is
concerned unless the VSO or the service organization is
specifically putting that veteran's claim number in there is no
way for the veteran or the accredited representative to know.
So we need this type of information as well.
Mr. Bergman. Thank you.
Mr. Bost. Ms. Brownley?
Ms. Brownley. Thank you, Mr. Chairman. And thank you all
for your testimony. It seems to me that this, you know, a
pretty simple problem to resolve and there should be ways in
which it can be resolved. And you know, I would just ask the
Chairman and the Ranking Member if, you know, we do not have
the VA here now, and so we cannot ask them that question. But
we need to ask the question, you know, when are you going to
take these recommendations and when are you going to have a
response to them? We believe it is a priority and we want to
make it a priority for you. And when will that happen and when
can they report back to us on it to make sure that it does
indeed happen?
I mean, it is, you know, within the VA sent out a fact
sheet, you know, when this process was going to be
incorporated. And they made a strong commitment that the
relationship between VSOs and the RO managers will not change
as a result of this new process, NWQ. Clearly you are making it
very clear to all of us that that is not the case. So
timeliness of these benefit claims are clearly important. But
the quality of those claims and the role that you play and the
relationship to the veteran at home is equally as important. So
I hope that we can clear this up sooner rather than later.
I just wanted to ask do the, can the veterans check the
status of their claims through the e-Benefit accounts?
Mr. Hearn. Yes, they can. But it is not like Domino's where
you know for certain they are putting the cheese on the pizza.
Sometimes they say they are putting the cheese on the pizza but
they are just putting the sauce. I mean, it is a different, it
is not a good reporting structure. And--
Ms. Brownley. It is not a good reporting structure
because--
Mr. Hearn. In other words from the input that we have
gotten, I will get calls from veterans in my office. And they
will say, you know, e-Benefits says this. And I will be looking
at VBMS and it is not matching up exactly. And so, and then so
I have raised this issue before with VBA going back years. And
I have said, you know, again using Domino's as an example, if
they can figure this out as far as whether, you know, what
toppings they are putting on the pizza, why cannot VA use a
similar technology? And I have never really gotten a good
response on that. To me that would be an easy solution, like
you were talking about.
Ms. Brownley. Okay. Well I guess I do not, I really do not
have any more questions. It seems the problems have been laid
out pretty clearly and I think to resolve it seems to be pretty
simple. So I will yield back.
Mr. Bost. Mr. Coffman?
Mr. Coffman. Thank you, Mr. Chairman. Let me ask each of
you first, do you think that the claims process, when they
switched to the new system were the claims processors up to
speed and ready to go? Were they trained up for this? Mr.
Hearn, let us start with you.
Mr. Hearn. By claims process do you mean on VA's side or
our representatives?
Mr. Coffman. VA's side.
Mr. Hearn. I, anytime you implement a new system there are
going to be problems, I think. And so, but at large I would say
that they were trained on how to do it. I think one of the
things that we need to caution with is that everything is
getting more electronic, right? Everything, they are sitting
there, they are gleaning all this information out of the
system. No baseball umpire is a computer. We still need the
human element in this. And there is too much reliance within
the network when they are saying, if the computer shows that
this could be potentially an error to avoid a quality review
hit they will not override that. And that has sometimes been
some of the problem that we have noted in there. But as far as
their understanding of the system, it has been my experience
when working with the employees that they have been properly
trained.
Mr. Coffman. Mr. Gallucci?
Mr. Gallucci. I would tend to agree that there was proper
training prior to implementation. However, because this was
such a complex overhaul I think the unforeseen consequences
made it much more problematic at least on our end as VSOs,
whether just how much work was moving around. I think even, and
I pointed out in my testimony that they had moved work for the
pre-discharge program, benefits delivery discharge claims.
There were hiccups all up and down the VA system on this. Our
rating review specialists in Winston-Salem had identified a
number of claims that were disappearing during the 48-hour
queue. When we reported it to VA they did not think it was
happening at first. It took about two days of back and forth
and then providing claim numbers and a hard count of the claims
that were pulled back from Winston-Salem pending rating review,
there were ten of them, that were assigned to the cloud, the
station of jurisdiction 499 for the national work queue. They
did not believe us at first. They almost did not recognize that
this was happening within their own business process. So I
think there were a lot of unforeseen complications with the
rollout of the national work queue. Again, one of the reasons
we wanted to come here today and articulate this, not to take
too many shots at VA, but we want to be a constructive partner
in this and this is what we are seeing on the ground. And we
hope that they will be responsive to the needs of our clients,
the veterans that we serve.
Mr. Coffman. Ms. Yoon?
Ms. Yoon. Thank you for the question. I would agree that I
think the training was generally sufficient. However, the one
thing that was exposed is that at each RO they often have their
own internal procedures and systems. And when a claim is sent
to another RO, and if we are used to a certain system at this
RO, the other RO might do something else. The lack of
consistency across each office has I believe been more apparent
and the hope is in the near future that that is something that
could hopefully be standardized more.
Mr. Coffman. Okay. Well very quickly, if you all had to,
you know, we are I think over 90,000 in terms of our claims
backlog right now. And so we have made some progress but we
have got a lot of progress to go. What would you, if you were
going to identify one issue as the leading issue that the
Veterans Administration needs to change in order to reduce the
backlog, what would that issue be? Mr. Hearn, let us start with
you.
Mr. Hearn. That is a big question, Congressman. Honestly I
think as, this is not going to impact the backlog as much as it
is going to impact the appeals and the quality of the
decisions. But is to stop and look at what you are doing as a
rater and as a VSR, and make sure that you are considering the
entirety of the evidence. Because that has been one of the
biggest problems that we have seen. It is the reason why you
have got a 50 percent remand rate at the board. It is the
reason why you have got a 25 percent grant rate at the board.
It is because nobody is sitting back and really thinking about
what they are doing when it comes to these decisions.
Mr. Coffman. Okay. Mr. Gallucci?
Mr. Gallucci. Congressman Coffman, thank you for that
question. I think you saw my head nodding a number of times.
Because it has to do with conflating timeliness and accuracy.
There is so much focus on the time it takes to get a claim
done, we have to get them out the door, we have got to move
through this process fast, fast, fast, fast, fast. And we are
finding that haste makes waste. I mean, it is a common
euphemism but pardon my dad joke. But it really becomes a
problem because our clients come to us for that personal
interaction to know that we have reviewed their records, that
what we are claiming is accurate, that VA took into
consideration the entirety of evidence. And it really makes it
easier on the back end. I believe now the Board of Veterans
Appeals docket date is backlogged several years. And that is
just harder on those veterans. Yes, they may have a rating
decision but it is probably an inaccurate rating decision. We
want to get this right the first time.
This also becomes a problem with the 48-hour review because
sometimes we have been told, well, we just need to get the
rating out there. The veteran needs that rating quickly. We are
talking about two days in a 125-day process. And the clients
that we work with they understand that if they get two days for
a quality check it is really not going to affect their, well it
will only affect their benefits for the positive on the back
end. That two days is ample time for them to make sure that the
rating decision is accurate. So thank you.
Mr. Coffman. Ms. Yoon? Quickly, I am over time here.
Ms. Yoon. Yes. Yes, I would emphasize possibly to
reevaluate the work credit system that VA employees have.
Because again there is this emphasis on speed and there is not
as much of an emphasis on accuracy. And again, our accuracy
measurements may be a little different than VA's accuracy. But
there needs to be an emphasis on reviewing the entire claims
file, development, looking to see if there is any more
development that is needed, and also most importantly if an
exam has been issued, was that exam adequate? And I think that
that, one of the most common reasons that we see cases kick
back from the board is because the exam is inadequate. And I
think that that is an example of something that can be worked
on and improved at VBA.
Mr. Coffman. Mr. Chairman, I yield back.
Mr. Bost. First off, let me say thank you for being here.
But also let me tell you that the Chairman in the new position
that he has made an error. The error is that I let the VA leave
this room before you spoke. I will not do that again. I think
that they should be here. I think that your answers, you should
get answers to those questions. And if it needs to be done in
front of this Committee, that is exactly where I think it needs
to be done. So that we can actually hold them accountable.
Because they can, I think the idea and intent of this program
is good. We want the process to be as smooth as possible. But
when it takes away your ability to be the advocates that you
need to be and you have, not to say the VA does not have their
best interest, the interest of the veteran, but you being the
overseers that you are, we want to have you have that
opportunity to do that. We will redo this at some time and make
sure that we can tell the VA we want to see a progress date of
where we are at and where the communications are opened up with
you. I say that with this Committee that we will definitely
move forward with that and we will have, we will do this again.
So thank you so much for being here today.
The Committee is adjourned.
[Whereupon, at 12:04 p.m., the Subcommittee was adjourned.]
A P P E N D I X
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Prepared Statement of Thomas J. Murphy
Introduction
Good morning, Chairman Bost, Ranking Member Brownley, and Members
of the Committee. Thank you for the opportunity to discuss the
implementation and progress related to VA's National Work Queue (NWQ).
The NWQ is a workload prioritization and distribution tool designed to
match claims assignment capabilities with VA workforce capacity,
regardless of state jurisdictional boundaries. This technological
capability provides the means necessary to ensure Veterans receive a
more timely decision on their disability compensation claims. The NWQ
uses sophisticated system capabilities to uniformly prioritize VA's
electronic claims inventory and allows for the collection of enhanced
data on processing efficiencies, areas for quality improvement, and
issues impacting claims processing capabilities. This new environment
allows VA the flexibility to move claims to locations around the
country that have the capacity to take the next action on a Veteran's
claim while maintaining the flexibility at each facility to assign work
to the appropriate personnel.
Impact on Efficiency
All Veterans deserve prompt and accurate delivery of all benefits
including those related to their disability compensation claims. The
implementation of NWQ is yet another large step towards that goal. One
of the principal fundamentals of NWQ is to ensure that Veterans are
served equally, regardless of where they live. A review of disability
compensation claims completed in fiscal year (FY) 2015 shows that, in
many instances, the timeliness of decisions rendered was significantly
impacted based solely on the state in which they lived. Some Veterans
were receiving claims decisions in an average of 106 days, while other
Veterans' claims decisions took more than 213 days on average-an
unacceptable range of 107 days-nearly double the days taken to process
claims in the regional office (RO) with the best processing times.
This variance demonstrates the inherent inefficiency in the RO-
based claims model, where each RO receives claims based on geography
rather than their capacity to complete the work. This variance would be
much greater had VA not redistributed claims through its brokering
plan. However, a monthly, manual brokering strategy is labor intensive,
time consuming, cost prohibitive, and does not sufficiently address the
variance in our processes.
NWQ's role in reducing the geography-based variances contributed to
an overall timeliness improvement during FY16. In March 2016, VA began
a staggered release of NWQ to certain ROs, with deployment to all ROs
implemented in May 2016. At the onset of our deployment, the average
days pending for Veteran's disability compensation claims nationwide
was 94 days, reduced to 85 days by the end of the fiscal year-a 10
percent reduction. While other factors beyond NWQ also contributed to
this reduction in the average days pending, including overtime and
expanded use of contract medical examinations, VBA's new capability to
put actionable claims into the hands of its workforce cannot be
overlooked. While the current average days pending has increased above
pre-NWQ deployment levels during FY 2017, that is a by-product of
increased receipts and other factors not necessarily related to NWQ.
VA's claims adjudication process involves many policies designed to
ensure that VA fulfills its statutory obligation to assist Veterans
with their claims. VA breaks the process down into cycles. Upon receipt
of claims for disability compensation, VA develops evidence, to include
examinations and records from private and military providers. Thanks to
the continued efforts of our employees and the capabilities of the NWQ
tool, VA reduced its inventory of claims awaiting initial review from
approximately 56,000 claims to 34,000 claims by the end of the fiscal
year. This inventory has been further reduced to approximately 18,000
as of the end of January 2017. The average number of days a claim
awaited first development action has dropped from almost 25 days to
less than 10 days in FY 2017.
Following the initial development actions and any follow up actions
required to gather all necessary evidence, VA prepares a rating
decision to identify each disability, its severity and its relationship
to military service. As described above, there are several factors,
together with the deployment of NWQ, that contributed to improvements.
However, since implementation of NWQ, VA's inventory of claims that are
developed and awaiting a rating decision has increased, but with the
ability to distribute work automatically across the country, the amount
of time claims that are awaiting a rating decision has dropped from
about 29 days to 16 days.
Once a rating decision is completed, VA prepares award and
notification for the Veteran, as appropriate. The increase in work
completed in the rating decision cycle, due both to NWQ and other
factors, also increased the number of Veterans' claims awaiting award
from almost 9,500 to nearly 12,500, yet the time awaiting award action
has dropped from 8 days to 4 days. Final awards are reviewed by a
senior claims processor, and the queue awaiting their review and
authorization has increased from almost 3,500 to 5,100, yet the time
awaiting authorization has decreased from more than 4 days to less than
2 days.
Impact on Average Days Pending
VA continues to work toward reducing the amount of disability
compensation rating claims pending over 125 days. While we acknowledge
that some claims will take more than 125 days to complete, we have made
significant improvements over the past two fiscal years. In FY 2015, VA
completed 45 percent of claims within 125 days, improving to a timely
completion rate of 64 percent in FY 2016. Through January 2017, 66
percent of disability compensation claims were completed within the
125-day standard. However, it is important to note that we will not
disadvantage Veterans by compromising accuracy in exchange for
expediency and we will continue to fully develop claims (which includes
considering all evidence, requesting additional evidence or medical
exams as needed, and take actions on new medical conditions added
throughout the claims process) to ensure each Veteran receives the
benefit to which he or she is entitled. We will continue to work with
Veteran Service Organizations (VSO) and other stakeholders to increase
efficiencies in these areas to reduce processing time.
Dependency on the Veterans Benefits Management System (VBMS)
NWQ is a component of VBMS, VA's claims-processing platform, and is
inextricably linked to the continued success of VBMS, the primary
technology component of VA's modernization efforts. VA continues to
develop VBMS in an agile methodology, in order to address changing
needs and priorities.
While we know there is more work to be done with regards to VBMS,
we continue to focus efforts on generating positive and significant
results. VBMS is poised to capitalize on our achievements to date and
drive continued improvements in claim processing timeliness, accuracy,
and transparency.
Emphasis on Quality
As previously stated, NWQ is a component of VBMS and one feature
that is built into the NWQ allows VA to measure the amount of rework in
our system, which we were not capable of measuring prior to VBMS and
NWQ. Rework is a classic non-value added step in a process. Reducing
rework will further improve efficiency in our disability claims
process. VBMS allows any VA employee in the process to ``stop the
line'' to correct a deficiency in process or an error in the decision,
a process similar to that used in industry to ensure high quality. VA
employees began using this process following NWQ deployment in May
2016, and VA has seen increased numbers of claims returned to an
earlier stage for correction.
Because of this feature, we are now able to measure process defects
based on feedback from our employees. As a result, approximately 6,500
claims reviewed in FY 2017 to date have been returned to an earlier
stage for correction, for reasons including missing or incomplete
development, missing exams, incorrect notice letters, or effective date
errors. Systematically tracking these errors at the lowest level
enables us to tailor our training to correct our most frequent
occurring errors and increase accountability in the claims decision
process. VA joins Congress, our VSO partners, and Veterans themselves
in our collective desire to improve the quality of VA's disability
claims process.
Training and Change Management
With an endeavor this large, VA expended a significant amount of
time and resources on a measured change management approach to NWQ
implementation. Our efforts included briefing various stakeholders,
training employees, publication of an NWQ Playbook for field users, and
a myriad of calls and briefings with each VA RO as deployment
activities ensued.
Although field personnel have gained experience in the new claims
environment, the change management and training efforts continue. VA
has utilized new data to revise Director- and employee-level
performance metrics and has created a standard suite of reports that
personnel use to improve workload management and effectively manage
their resources. Additionally, VA committed to bringing together more
than 1,100 first line supervisors and division level managers for
continued training on tools and best practices.
Conclusion
While VA is acclimating to this new work environment and learning
to optimize assigning work to existing capacity, we have taken the
feedback from our employees and stakeholders to heart and are
implementing methods to increase the amount of local work assigned to
our ROs. This will allow VA to continue to leverage the proficiencies
that often come from familiarity to further improve efficiency and
increase accountability for work actions completed by each RO. While we
acknowledge that there is more work to be done, it is important to
recognize that these claims transformational efforts have and continue
to generate positive and significant results for Veterans.
I look forward to your continued support and commitment on behalf
of Veterans, their families, and survivors. Thank you for allowing me
to address the Committee today. Mr. Chairman, this concludes my
statement. I would be pleased to answer any questions you or other
Members of the Committee may have.
Prepared Statement of Zachary Hearn
Chairman Bost, Acting Ranking Member Brownley, and distinguished
members of the Subcommittee on Disability and Memorial Affairs (DAMA),
on behalf of National Commander Charles E. Schmidt and The American
Legion; the country's largest patriotic wartime service organization
for veterans, comprising over 2 million members and serving every man
and woman who has worn the uniform for this country; we thank you for
the opportunity to testify regarding The American Legion's position on
``Exploring the national work queue's impact on claims processing''.
Background
The National Work Queue (NWQ) is a paperless workload management
initiative designed to improve the Veterans Benefits Administration's
(VBAs) overall productive capacity and assist with reaching the
Secretary of Veterans Affairs' (VA) goals of eliminating the backlog by
processing all claims in 125 days with improved accuracy. The NWQ is
designed to serve as an efficient method to process, develop, and
adjudicate veterans' claims.
The premise behind the NWQ is to avoid funneling cases singularly
through the local VA Regional Office (VARO); instead, its objective is
to maximize VA's workforce at its 56 VAROs to avoid delays in
developing and adjudicating claims that plagued the Veterans Benefits
Administration (VBA) in recent years.
In response to the mounting backlog of disability claims, VA
created an electronic claims network called the Veterans Benefits
Management System (VBMS) to electronically process veterans' claims.
The implementation of VBMS has been credited with assisting in the
reduction of the backlog that peaked at 611,073 claims in March 2013.
With the implementation of VBMS and the elimination of hard-copy files,
VA gained the ability to electronically distribute cases throughout its
network of VAROs. Through this, the objective was to maximize its
workforce, reduce the burden on certain VAROs suffering from under
staffing, with the ultimate goal of having claims adjudicated in a more
expeditious manner.
Beginning in mid-2015, VA began discussing with veterans service
organizations (VSOs) the NWQ and the program's implementation. By 2016,
the NWQ was fully implemented and cases that were previously processed,
developed, and ultimately adjudicated at a claimant's local VARO could
have been handled by VA employees at numerous VAROs.
During the creation and implementation phase of the NWQ, The
American Legion received multiple briefings regarding the program. We
acknowledged that this program would provide a more efficient manner to
have claims processed; however, improvements to VBMS would need to be
made to ensure that accredited representatives would be able to
maintain contact with VA adjudicators throughout the nation.
Additionally, there would need to be a notification system installed
for accredited representatives so that they would know when a claim
adjudicated in another location requires a review.
The American Legion is a decentralized organization. Many of our
service officers working within VA's network of regional offices are
state employees, funded by state taxpayers. Concerns surrounding the
assistance of veterans residing outside of a service officer's state
have been raised to The American Legion. These same concerns have been
raised by The American Legion to VA. Despite these concerns, VA has yet
to provide the necessary adjustment to VBMS to ensure the local
representative can review the case.
Over the last 18 months, numerous complaints have been provided to
The American Legion's National Headquarters regarding the
implementation of the NWQ. Based upon these concerns, The American
Legion passed Resolution 104 during the 2015 National Convention in
Baltimore, Maryland stating, ``VA inform representatives at the local
VAROs of decisions by placing a filter in (VBMS) allowing local
representatives to find their client's VBMS records, including but not
limited to, rating decisions by conducting the client's state of
residence search''. \1\
---------------------------------------------------------------------------
\1\ American Legion Resolution No. 104 (Sept. 2015): Local
Accredited Representative Access to Veterans Benefits Management System
Decisions
---------------------------------------------------------------------------
To illustrate the frustrations of veteran service officers, The
American Legion's veteran service officers employed by the Minnesota
Department of Veterans Affairs (MDVA) contacted The American Legion
recently pertaining to the NWQ; while MDVA communicated these concerns,
they echo many of the sentiments we have heard from our field
personnel. They identified the following concerns regarding the NWQ and
its impact upon the adjudication of claims:
Glaring inconsistencies in development and adjudications
between VAROs;
Lack of ability to communicate with VA personnel directly
responsible for claims' adjudication;
VA is removing the ability to review adjudications less
than 48 hours following some adjudication;
Removal of mail and notification lists in the process
have resulted in an inability for service officers to properly review
claims' adjudications prior to promulgation;
VA notification letters indicate that the power of
attorney (POA) has received a courtesy copy of the correspondence. This
indication is disingenuous; while true that the POA can review the
correspondence on VBMS, there is no copy delivered to the POA and most
often, do not know about the correspondence unless a review of the case
occurs or the veteran contacts the POA; and
A lack of ownership of the claim by VA personnel.
Previous to the NWQ, VA local employees had greater ownership of the
development and adjudication of claims; since the NWQ's implementation,
a fracture between VA and service officers has occurred in
communication and partnership due to frequently receiving little to no
response from VA personnel at separate locations.
The lack of communication and ability to effectively advocate for
veterans has proven terribly frustrating to many of The American
Legion's service officers. It has added to an increased level of
distrust; some service officers have reported an increase of VA
personnel starting to appeal the decision to the Board of Veterans'
Appeals (BVA), because of the perception of an increased level of
authority. The frequency of the statements rose to the level that The
American Legion contacted VA's Office of General Counsel (OGC) to
question the validity of the statement. In a response to The American
Legion on December 12, 2016, OGC stated, ``It is not accurate to say
that the (BVA) has greater authority than the (VARO) to grant benefits,
or any authority at all to circumvent the law and award benefits at
will.''
The American Legion's service officers in Minnesota also reported
that they were misled regarding the distribution of claims of their
veterans. Initially, they were informed by VA that the NWQ would result
in 99 percent of Minnesota veterans' claims being adjudicated at the
St. Paul VARO. Statistics do not bear true, however; since the NWQ's
implementation, the number has reduced drastically to only 30 percent
of veterans in Minnesota having their claims adjudicated within the St.
Paul VARO.
Annually, The American Legion visits VAROs as part of the Regional
Office Action Review program. Last year, The American Legion visited 10
VAROs; beyond reviewing the quality of adjudications with the VARO, we
have the opportunity to meet with senior leadership and line employees
at the sites. Significant concerns regarding the NWQ were raised from
veteran service representatives through senior VARO personnel.
Common complaints from VA personnel were about the inability to
have ownership of local claims, and one VARO could complete the
majority of the work surrounding an end product (EP), if the product is
not completed by the end of the business day, it could be reassigned in
the NWQ to another station with the new station gathering the credit
for the work. A senior VARO employee expressed that the organization
operates in a production environment, and yet the proper credit for the
production is not necessarily being applied. While service officers
would prefer that all claims were adjudicated within their local VARO,
most also recognize that the complexity of claims and the need to
adjudicate the claims in an efficient manner needs to exist. We
recognize the importance of the NWQ; however, the efficacy of the NWQ
and the support of the program does require support of the veteran
service organizations (VSOs).
For nearly two years, VSOs have been briefed regarding the NWQ, and
during that span, we have advised VA of the needed changes to VBMS to
allow the NWQ to be successful. VA continually states that they
recognize VSOs as key stakeholders; however, if VA continues to fail to
listen and implement the suggestions by the VSOs.
The American Legion's service officers support a thriving VA; we
have a fleet of advocates exceeding 3,000 accredited representatives
that are available to support VA in its efforts to improve the delivery
of benefits - but VA needs to listen and address our concerns. For two
years, we have been advised that our suggestions are not ``high
priority'' if you are a key stakeholder and have been provided this
statement for this period of time, it is natural to wonder how ``key''
of a stakeholder you are. To be clear, service officers are not a
hindrance to the process, they could be a powerful part of the
solution.
The efficacy of the NWQ rests upon VA making the necessary
following adjustments:
Improving the standardization of adjudications
nationwide;
VA creating an environment where they are encouraged to
communicate with service officers regarding individual claims. The
creation and use of an informal conference could be included in the
point system to increase participation and potentially reduce appeals;
Create a notification/mail system to alert the local
service officer of actions taken on a case;
Rater does not receive points assigned to the EP until
the service officer indicates completion of adjudication review;
Creation of an alert from the service officer to the
adjudicator indicating a concern surrounding adjudication. Through this
implementation, VA could avoid numerous appeals simply through having a
discussion with the service officer;
Provide hard copy decisions if the claim has not been
electronically processed, the Power of Attorney (POA) does not have
access to the e-folder within VBMS, or if a rating decision or
correspondence is generated with the EP being cleared the same day
Include examination requests in VBMS; POAs have no
knowledge if the process is being correctly executed; and
Do not permit VA employees to remove an adjudication
awaiting review until two full working days have expired.
Conclusion
The American Legion thanks this committee for their diligence and
commitment to our nation's veterans as they struggle to receive the
benefits they have earned for their service to the country. The
American Legion appreciates the efforts VA has made to improve
processing claims. When one considers the backlog of claims we all
experienced less than four years ago, there has certainly been great
improvement. Success and improvement does exist however; veterans'
claims needs to be adjudicated in a timelier fashion. The American
Legion is simply asking for VA's focus not to be solely on VA but to
the fleet of thousands of advocates that work with VA on a daily basis.
Through this cooperation, we are confident that the NWQ can be a viable
product for future claims' adjudications. Questions concerning this
testimony can be directed to Warren J. Goldstein, Assistant Director in
The American Legion Legislative Division (202) 861-2700.
Prepared Statement of Ryan Gallucci
MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:
On behalf of the men and women of the Veterans of Foreign Wars of
the United States (VFW) and our Auxiliary, thank you for the
opportunity to offer our perspective on how the Department of Veterans
Affairs' (VA) deployment of the National Work Queue (NWQ) has affected
the disability claims process.
First, VA should be applauded for implementing a national workload
management solution to ensure that work can be performed at a
consistent level of quality to deliver timely and accurate benefits to
our nation's veterans. In the cloud-based Veterans Benefits Management
System (VBMS), the VFW believes that efficiently brokering work to the
station best equipped to handle the task is a responsible and
innovative method to improve the overall disability claims process. The
VFW knows it has been a persistent challenge for VA to ensure
consistency and timeliness in its rating decisions for veterans across
all of its offices. By implementing the NWQ, VA now has the ability to
track the consistency of its work and ensure that VA employees complete
tasks to standard.
Make no mistake, the NWQ certainly speeds up the VA claims process,
which is generally positive for veterans. If business processes can be
completed efficiently by VA regional offices that have the capacity,
this makes sense to VA and ultimately delivers timely benefits to
veterans. Unfortunately, in deploying NWQ, VA seems to have focused
solely on speed and consistency, but neglected the customer-facing side
of accuracy.
The VFW believes that VA has an obligation to ensure consistency
across this rule-based system to foster the best possible outcomes for
veterans. However, VA must remember that its partner Veterans Service
Organizations (VSOs), like the VFW, play a critical role in this
cumbersome process as advocates whose inherent function is providing
quality customer service to the veterans and eligible dependents who
seek our assistance. Simply put, we meet face-to-face with veterans who
need help navigating the VA benefits system. As VA-accredited
representatives, we train our advocates to not only understand health
care records and the VA benefits system, but also how to serve as
empathic stewards of highly sensitive information. When we take power
of attorney for a veteran client, the veteran is placing his or her
trust in the VFW to serve as a quality advocate in not just filing for
VA benefits, but also ensuring any awarded benefits are accurate.
The VFW cannot overstress the customer-facing aspect of our job.
The primary reason our network of service officers exists is so that
our veterans do not need to worry about deciphering health care
terminology or memorizing the VA rating schedule in 38 CFR just to file
a claim for earned veterans' benefits.
The VFW provides up to 80 hours of training every year to our
accredited representatives to ensure they remain proficient in
understanding the VA benefits system. Our representatives then have the
responsibility to meet with veterans in person to help develop evidence
in support of their VA claim, as well as ensure paperwork is filled out
properly and submitted in a timely manner. What this means is that our
representatives are proficient in understanding military and civilian
health care recordkeeping, and must develop a keen eye in identifying
claimed conditions and evaluating these conditions against the
prescribed VA regulations for compensation. Moreover, our
representatives must develop a rapport with their clients to help
identify any lay evidence that would support their claim, such as
statements from family members or fellow veterans that can
contextualize symptoms or validate in-service incidents.
VA claims are highly complex and small variables can make a
difference in the accuracy of a veteran's rating decision. One of the
VFW's contract trainers, Frank Bongiovanni, puts it best when
explaining our objective as accredited veterans' advocates: ``[VA
claims advocacy] is the confluence of health care and law. If you
wanted simple, you're in the wrong line of work.''
VA has long recognized that VSOs are constructive partners in the
benefits claims process, which is why VA has long afforded accredited
VSOs in VA regional offices the opportunity to review proposed rating
decisions for accuracy. This 48-hour review period outlined in VA's
Manual 21-1 provides our accredited representatives with one last
opportunity to perform a quality check on rating decisions. Our
objective is to ensure that errors are caught and addressed before the
rating decision ever reaches the veteran.
Based on the VFW's most recent analysis, we find errors in about
one out of every 10 claims, and we usually can work with VA to fix them
prior to promulgation. This is not only a positive for the veterans we
serve, but this is also a benefit to VA. On a grand scale, if VSOs can
perform quality reviews on all ratings prior to promulgation, and
explain the context of rating decisions to our veterans, we will cut
down on appeals and build confidence in the VA system. On a local
scale, VSO representatives will learn how to become stronger advocates;
VA staff will learn how to be more meticulous raters; and veterans will
receive consistent, accurate, and timely benefit decisions.
Unfortunately, as the NWQ moves work quickly across VA, the final
step in the process has the potential to throw the whole system off,
sullying the veteran's experiece. Under the current system, when VA
proposes a rating decision, raters will post the decision for the 48-
hour VSO review in VBMS. By default, this rating will populate in the
``All Claims Queue'' for the VSO located at the office where the claim
was rated. However, the VSO located where the claim was taken will not
be notified in any way that a decision has been proposed. These VSOs
can search for their individual veterans by name or utilize a very
limited zip code filter to try and track their local clients, but they
immediately lose optics on the claim. This practice of posting ratings
in offices other than the original office becomes problematic because
it does not take into account current technological limitations of VBMS
to search for and find unique groups of veterans; it does not account
for current M21-1 guidance that allows for immediate promulgation for
certain brokered claims; and it discounts the role of VSOs in providing
quality customer service to veterans we serve face-to-face.
Moreover, VA currently does not offer an opportunity for VSOs to
flag potential errors in decisions in VBMS, relying solely on local
employees complying with VA guidance to address errors. This means that
VA cannot track this as a quality metric on the back end or hold
employees accountable for complying with guidance on responding to
potential errors. The VFW's objective in this testimony is to
demonstrate why VA must consider VSO priorities to be shared
priorities, and how each of our concerns is intertwined with how VA
improves its workflow through NWQ to provide the best possible customer
experience for veterans.
With regard to technology, the default view for our service
officers in VBMS is the ``All Claims Queue'' and this reflects active
workload for which the VFW has power of attorney in the office where
the claim is rated (Station of Jurisdiction, or SOJ). This workload
changes day to day, which makes it nearly impossible to track the
clients our advocates have met with in person. As this work moves
around, our service officers are instructed to review any claim that
populates in their station's work queue in VBMS. Our service officers
have worked in good faith to do this, but many are concerned that the
needs of their local clients should come first.
For those seeking to balance the local and national objectives in
providing quality customer service, VA has presented several work-
arounds to help track locally-generated work. However, this presents a
dilemma. Do our service officers support the individual veterans that
they met with face-to-face? As local, public-facing advocates, we
believe this obligation is paramount. These are the veterans who call,
email, and personally visit the office, looking for peace of mind and
guidance throughout the VA claims process.
However, our service officers are part of a larger VA business
process that requires adherence to certain policies and procedures to
function efficiently and deliver consistent quality decisions to all
veterans. As good faith partners located in VA facilities, do the
interests of the broader VA mission come first?
Finally, in the case of the VFW, many state governments and VFW
local organizations have made significant financial investments in
service officer programs to ensure the needs of local veterans can be
met. As responsible stewards of these financial resources, is it
irresponsible to deviate from this objective? Moreover, many VSOs like
the VFW have aligned resources at VA regional offices to sufficiently
serve the local veterans' population or to support the VA special
missions assigned to specific offices. This presents logistical
challenges in handling the influx of rating decisions generated through
NWQ and creates confusion over responsibility and optics on special
missions.
An example of this local mismatch comes from the VFW office in
North Dakota. The VFW's service office is staffed by two personnel to
reflect the size of the veterans' community in their region. However,
when NWQ rolled out, this service office was inundated with brokered
rating decisions. Our service officer in North Dakota now reports that
his rating review workload largely consists of brokered claims for
veterans he has never met. Meanwhile, he has lost optics on the local
veterans who turned to his office for help, as the North Dakota
workload moves from station to station. He warned our office that the
veteran has ``lost local advocacy'' because of NWQ.
An example of the special mission confusion comes from the VFW's
Benefits Delivery at Discharge (BDD) program, which is responsible for
helping transitioning service members file VA benefit claims on 20
military installations. When VFW built its BDD program, we aligned our
resources with the VA regional offices responsible for developing and
promulgating decisions for BDD and Quick Start (QS) claims --Winston/
Salem, North Carolina, and Salt Lake City, Utah. When NWQ was being
built, VSOs were assured that special work like BDD would be worked
only at the stations dedicated to those special missions.
Unfortunately, this was not the case in implementation. Our staff
located at these special offices started to notice discrepancies in
their claims queues, noticing that work was disappearing while it
should have still been available to review. They started to
meticulously track these claims and not only found brokered BDD work in
10 other VA regional offices, but also found more than 40 BDD and QS
claims assigned to the NWQ cloud (SOJ 499), some of which were still on
the 48-hour clock, and others which had expired.
The VFW reported this discovery to VA. VA staff at first seemed
surprised to learn about this, but then seemed nonchalant that this was
going to be the way forward for not only BDD and QS claims, but
potentially for other special work like pension claims. The VFW
implores VA to reconsider this decision and ensure that they consider
the alignment of VSO resources and the needs of the veterans we serve.
Our service officers in the field consistently demonstrate that
they must build trust and credibility with not only their clients, but
also their local VA colleagues to properly advocate for their clients.
When these service officers do not have the opportunity to review the
work for their clients, everybody suffers. At first, it may look good
that VA was able to send the rating to the veteran more quickly, but
this is no good if the decision is inaccurate and if our advocates have
no way to explain the rating decisions to our veterans.
Over the past two years, the VFW and our partners have tried to
articulate this dilemma in many different ways to encourage VA to
provide our representatives with the tools they need to monitor the
work for veterans they serve face-to-face. To this point, the work-
arounds we have been offered have not achieved the desired outcome. The
first such work-around was the ability for our representatives to sort
lists of clients by zip code. However, this proved impractical as some
regional offices serve hundreds of zip codes. Moreover, the zip code
sort filter in VBMS is restricted to a certain number of fields,
meaning offices responsible for larger catchment areas, such as our
operation in the St. Petersburg VA Regional Office, could never
possibly sort their clients via zip code.
Next, VA is proposing to build a new field in VBMS through which
VSOs could sort by the station where each claim originated (Station of
Origination, or SOO). This is a significantly improved work-around, but
again, it is only a work-around. The VFW acknowledges that our
representatives would be able to sort by the work that originated in
their station. However, this does not resolve the business process
dispute that often results in claims moving directly to promulgation in
lieu of offering 48-hour VSO review, as outlined in M21-1.
According to the current M21-1, VA raters are instructed to follow
very specific steps to post rating decisions for VSO review. However,
this becomes problematic for brokered worksites, like NWQ worksites,
which are allowed to directly promulgate a decision without offering
review, if no authorized VSO is available at the redistributed
worksite. After promulgation, the redistributed worksite is directed to
return the rating to the SOO. In a scenario where a brokered site
prepares a rating decision but no VSO representative is present, the
decision can be promulgated immediately regardless of whether or not
another VSO representative was tracking the claim in VBMS via one of
the proposed work-arounds.
The VFW recently experienced this with a client we are serving out
of the VFW Washington Office. The veteran was working directly with one
of our experienced service officers who serves in a management role
with the organization. This service officer checked VBMS regularly for
this specific client to ensure that our office would review the rating
decision for accuracy. However, the claim was assigned to a VA Regional
Office that recently experienced turnover in the VFW office. While the
VFW office was vacant, the regional office sent decisions directly to
promulgation in accordance with M21-1. Unfortunately, when our staff
member was reviewing the already finalized rating decision, he noticed
that the regional office failed to address one of the veteran's claimed
conditions. What ensued was an additional eight month hassle for the
veteran during which VFW's repeated messages to the regional office
responsible for the claim went unanswered. We finally started to
resolve the issue during a coincidental site visit to this regional
office by VFW national staff to provide onsite training to the new VFW
service officer.
The VFW would have caught this error immediately if we had an
opportunity to review this rating decision, and our client likely could
have avoided the additional headaches that came after the decision.
This is the worst possible situation for all involved. It not only
creates unnecessary stress for the veteran, but it also strains the
VFW's credibility as advocates and strains VA's credibility as a
benefits provider.
Given the current rules outlined in the manual and the practical
examples the VFW has seen, we believe VA would be best served to return
claims brokered through NWQ to the SOO for the 48-hour VSO review
period. To VA's credit, they seem to be coming around on what groups
like the VFW have been requesting. In a recent meeting with VA, NWQ
staff informed the VSOs that they are looking to leverage the data from
NWQ to monitor employee compliance with the 48-hour review period. This
is a positive step. If employees are cutting corners by promulgating
decisions before a proper review, they must be held accountable.
However, the VFW also asks that VA address the problem up front by
returning the claim to the SOO, and also allowing VSOs to flag rating
decisions in VBMS when we believe we have found an error.
Another challenge for NWQ is the process to address errors that
VSOs identify in rating decisions. At the moment, when a VSO identifies
a potential error, we are instructed to contact the Change Management
Agent (CMA) for the regional office responsible for the rating decision
via email. VA has issued guidance that CMAs should respond to these
inquiries within 24 hours. However, in the field, this process breaks
down. The VFW consistently hears from our representatives that they do
not receive responses in a timely manner, meaning that we must either
mark the claim as ``Reviewed'' or allow the review period to expire.
This means that our potential objection to a rating decision is never
documented in VBMS. The VFW instructs our service officers to log these
objections in our internal claims management database, but this is
completely divorced from VA's recordkeeping systems. This means that on
the VA side, they will see either expired ratings or discover erroneous
``Reviewed'' ratings of poor quality. This has the potential to erode
VA's confidence in our advocates, straining local relationships and
ultimately damaging credibility with the veterans we serve. Moreover,
this potentially obfuscates errors within the VA system, creating the
illusion that claims move through the system error-free.
To remedy this situation and help VA better analyze the quality and
consistency of its work, the VFW requests that VA allow VSOs to mark
ratings as ``Queried'' in VBMS. This will again provide a significant
benefit to VA in improving the quality of the product it delivers to
veterans. Not only will this help to automate the rating review
process, it will allow VA to hold its employees accountable for
addressing potential errors in the digital workspace.
Again, as VA's partners, the VFW believes NWQ can be a very good
system to help veterans receive consistent, accurate, and timely
benefits. We understand and support VA's initiative in resourcing work
based on capacity in a digital environment. However, the veterans we
serve expect us to provide the best possible customer service, and we
would be remiss if we were not candid with VA about the deficiencies we
see in its work products. As we have seen before, some in VA still
conflate internal efficiencies with quality outcomes for veterans. Our
shared interest in this process is to ensure the best possible outcome
for the veteran, and we hope that VA will recognize that our
recommendations are ultimately to improve the quality of our shared
work product.
We look forward to working with VA to further improve this system
and continue serving as quality advocates for the veterans we serve.
Chairman Bost, Ranking Member Brownley, this concludes my testimony and
I am happy to answer any questions you may have.
Prepared Statement of Kelsey Yoon
Good afternoon, Chairman Bost, Acting Ranking Member Brownley, and
other Representatives of this distinguished subcommittee. On behalf of
the VVA National President, as well as the members of Vietnam Veterans
of America (VVA), I thank you for affording VVA the opportunity to
testify today regarding the National Work Queue's impact on claims
processing.
The National Work Queue (NWQ) is an IT-based workload management
system that assigns claims to be adjudicated to a regional office (RO)
based upon capacity, instead of assigning the claim to an RO in the
state where the veteran resides. The goal of the NWQ is to eliminate
the backlog by processing all claims in 125 days. VA is considering
expansion of the NWQ to appeals and non-rating claims.
Pre-NWQ, all claims were adjudicated in the same state where the
veteran resided. This process permitted service representatives to
develop working relationships with VA claims raters at their respective
ROs to ensure that decisions were decided accurately and as early as
possible. Indeed, VA procedures require service representatives to have
48 hours (or 16 business hours) to fully review decisions for errors
before the decisions are formally promulgated. \1\ This vital step
ensures accurate decisions are issued as earliest as possible and
prevents the need appeal claims.
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\1\ See M21-2, Part I, 3.B.3.b (last updated 9 March 2016).
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However, since implementation of the NWQ, service representatives
are further distanced from the claims process, and in some instances,
blocked out entirely. Although VVA generally supports the use of
technology and VA's desire to move to a paperless system, the NWQ was
implemented without prioritizing the crucial role service
representatives play in the claims process. To date, VA has failed to
prioritize search features in VBMS for service representatives to
adequately review claims, neglected to provide accurate information
concerning how service representatives can connect with a claims rater
in a timely manner, and decreased transparency in rating decisions. VVA
believes that due to these deficiencies, we are unable to fix erroneous
decisions and are forced to appeal more claims.
VA's failure to prioritize the service representative review
process is tantamount to fostering an adversarial and anti-veteran
claims process. Although VA listened to veterans service organizations'
concerns before, during, and after the implementation of the NWQ, these
concerns continue to be put at the bottom of the priority list. VVA is
left concluding that VA is only interested in using the NWQ as a tool
to eliminate the backlog at the expense of decision accuracy. VVA
believes the prioritization of speed over accuracy is certainly not in
the spirit of a pro-veteran, non-adversarial claims process.
Therefore, VVA strongly opposes the expansion of the NWQ to appeals
and non-rating claims until, at a minimum, the following
recommendations are fully implemented.
1. Recommendation to prioritize the Station of Origin (SOO) requirement
in VBMS.
Currently, it is nearly impossible for a service representative to
competently assist their veterans through the claims process due to the
inability to search by Station of Origin (SOO) in VBMS. VBMS does not
have the functionality to allow service representatives to accurately
track claims that need review during the 16 business hour review
period. This request was first raised years ago, and it has still not
been prioritized.
The absence of the ability to search claims by SOO particularly
impacts VVA because we do not have a veterans service program in each
state to properly monitor claims activities at each RO. As a result,
the NWQ has forced VVA to assign multiple stations to a single service
representative; for example, two employees stationed at VVA's office at
the Appeals Management Office (AMO) cover 11 separate stations every
day. In addition to the ballooning workload of each employee, the
quality of review is diminished due to the lack of familiarity with the
claims file. This is an unacceptable outcome and an unsustainable
model.
VVA believes there is no feasible workaround until the SOO is
prioritized in the next VBMS update. Although VA indicates that it is
possible for service representatives to search by the veteran's zip
code, this is not a feasible workaround for VVA service representatives
who are covering multiple states or hundreds of zip code areas each
day. Additionally, on February 6, 2017, VA indicated that the zip code
filter function in VBMS is defective.
VA has been informed, for years, of the urgent need for this VBMS
requirement; however, it continues to be given zero priority.
2. Recommendation to publish CMA contact information for service
representatives and to establish pro-veteran protocol for service
representatives' claims reviews.
Pre-NWQ, when a service representative spotted an error in a rating
decision during the 16 business hour period, she would be able to
immediately call, email, or directly visit that VA claims rater to
discuss the error identified so that it could be fixed quickly. The
name of the RO was published on the rating decision and the name of the
claims rater was published on the rating code sheet, so it was easy for
the service representative to identify who to contact. This permitted
service representatives to develop collegial working relationships with
VA claims raters, and ultimately, assisted in preventing errors and
appeals.
Due to the NWQ, service representatives may now need to contact a
rater in another state where the claim is adjudicated. Unfortunately,
VA has failed to provide accurate information and consistent policies
concerning how service representatives can connect with a claims rater
in a timely manner if an error is identified. VA currently directs
service representatives to first reach out to the VA claims rater
directly if an error is identified. If the claims rater is not known,
which is usually the case for a NWQ-claim, VA instructs service
representatives to reach out to the Change Management Agent (CMA) at
the RO where the claim was decided.
Unfortunately, in practice, it is often impossible to reach a VA
representative at an unfamiliar RO to address a claim in a timely
manner. VVA believes this is primarily due to two reasons. First, VA is
unable to produce an accurate CMA contact list for service
representatives to use if we need to get in touch with someone quickly.
Second, even if a service representative contacts the appropriate CMA,
we often do not receive a response for weeks or the response does not
address the issues or questions raised. By this time, the decision has
already been promulgated, and the service representative is forced to
appeal the claim - often on the exact same grounds raised in the
original email to the rater.
Therefore, VVA makes the following two recommendations. First, VA
should publish an accurate list of CMA contact information for each RO
on its website. This list should be updated in real-time and should
include a name, email address, and phone number. Second, VA should
develop and enforce the following protocol for service representatives'
claims reviews: (1) CMAs or VA raters should respond to rating decision
inquiries within 8 business hours to confirm receipt; (2) the rating
decision in dispute is not permitted to be finalized until the service
representative's challenge is properly reviewed and answered; and (3) a
VA representative must provide a response to the service
representative's inquiry within 16 business hours.
3. Recommendation to include both Station of Origin (SOO) and Station
of Adjudication (SOA) on rating decisions and to include the full name
of the claims adjudicator on rating code sheets.
Previously, VA would publish the name of the RO that adjudicated
the claim and the name of the claims rater who made the decision on the
rating code sheet. This information facilitated the ability of service
representatives to quickly identify who they needed to contact if they
found an error with a decision. Moreover, by including this information
on each rating decision and code sheet, it increases transparency and
accountability of the claims process.
Recently, VA has removed both the RO name and the name of the
claims rater on rating code sheets. Because of these changes, it is
often difficult to identify which RO adjudicated the claim and it is
nearly impossible to identify who adjudicated the claim. This
information is necessary to have if we need to timely connect with a VA
claims rater to address an error. It is sometimes unclear in the
``notes'' section of VBMS where the claim was adjudicated; this is
especially true of a veteran has multiple claims being worked on at the
same time.
Therefore, VVA recommends that VA include both the Station of
Origin (SOO) and Station of Adjudication (SOA) on all rating decisions
and add the full name of the person who adjudicated the claim to the
rating code sheet. These changes will increase transparency of the
claims process and support the service representatives' ability to
quickly connect with the VA claims rater if an error is found.
In sum, the recommendations that VVA puts forth today seeks to
increase the accuracy of rating decisions and prevent appeals, supports
transparency and accountability of the claims process, and ensures that
the non-adversarial benefits system is truly working for the veteran.
VVA opposes the expansion of the NWQ to cover appeals and non-rating
claims until the issues raised today are fixed.
Thank you for this opportunity for VVA to share our thoughts
regarding the NWQ's direct impact on veterans and the claims process. I
am happy to answer any questions at this time.
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