[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
EXAMINING VA EFFORTS TO
DECREASE DELAYS IN VETERANS'
DISABILITY COMPENSATION CLAIMS
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HEARING
BEFORE THE
SUBCOMMITTEE ON DISABILITY
ASSISTANCE AND MEMORIAL AFFAIRS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, APRIL 9, 2025
__________
Serial No. 119-16
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
61-149 WASHINGTON : 2025
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COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
MORGAN LUTTRELL, Texas, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MORGAN MCGARVEY, Kentucky, Ranking
American Samoa Member
JACK BERGMAN, Michigan CHRIS PAPPAS, New Hampshire
NANCY MACE, South Carolina MAXINE DEXTER, Oregon
KEITH SELF, Texas KELLY MORRISON, Minnesota
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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WEDNESDAY, APRIL 9, 2025
Page
OPENING STATEMENTS
The Honorable Morgan Luttrell, Chairman.......................... 1
The Honorable Morgan McGarvey, Ranking Member.................... 3
WITNESSES
Panel I
Mr. Kenneth Smith, Assistant Deputy Undersecretary, Field
Operations, Acting Executive Director, Education Services,
Veterans Benefits Administration, U.S. Department of Veterans
Affairs........................................................ 4
Accompanied by:
Mr. James W. Smith, Deputy Executive Director, Policy and
Procedures, Compensation Service, Veterans Benefits
Administration, U.S. Department of Veterans Affairs
Mr. Robert J. Orifici, Executive Director, Benefits and
Memorial Services, Office of Information and Technology,
U.S. Department of Veterans Affairs
Mr. James "Jim" R. Swartz, President, AFGE Local 2823, American
Federation of Government Employees............................. 6
APPENDIX
Prepared Statements Of Witnesses
Mr. Kenneth Smith Prepared Statement............................. 17
Mr. James "Jim" R. Swartz Prepared Statement..................... 22
Statements For The Record
Disabled American Veterans Prepared Statement.................... 41
The American Legion Prepared Statement........................... 44
Veterans of Foreign Wars of the United States Prepared Statement. 55
EXAMINING VA EFFORTS TO
DECREASE DELAYS IN VETERANS'
DISABILITY COMPENSATION CLAIMS
----------
WEDNESDAY, APRIL 9, 2025
Subcommittee on Disability Assistance &
Memorial Affairs,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 1:44 p.m., in
room 360, Cannon House Office Building, Hon. Morgan Luttrell
(chairman of the subcommittee) presiding.
Present: Representatives Luttrell, Bergman, McGarvey,
Pappas, and Morrison.
OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN
Mr. Luttrell. The subcommittee will come to order. Thank
you all. Thank you to all of our witnesses for being here
today. We are taking a close look at the U.S. Department of
Veterans' Affairs (VA) efforts to decrease delays in veterans
disability compensation claims resulting from VA
overdevelopment. When a veteran files a claim for disability
compensation, VA has a duty to assist them with proving their
claim. This means helping veterans obtain service records and
medical records or scheduling veterans for VA disability
compensation exams. VA cannot make a decision on a veterans
claim until all development is completed. Although I hear from
veterans about how frustrating the wait is for a decision to be
made, many times VA efforts to obtain records and/or exams
leads to an award for disability compensation.
On the other hand, overdevelopment is when VA takes
unnecessary steps to obtain records or exams. Example, if
existing documents in the veterans claims file are sufficient
to support the claim, VA should not schedule a government-
funded disability exam. Overdevelopment forces veterans to wait
longer than necessary for a decision on their claims and can
lead to incorrect decisions. Unnecessary exams also waste
veterans time and money.
Further, if a veteran misses a VA scheduled exam without
good cause and they do not reschedule, VA automatically denies
the veteran's claim even when it was unnecessary for VA to
schedule the exam in the first place. H.R. 2137, the Review
Every Veterans Claims Act will absolutely fix this injustice.
Overdevelopment also drives government waste because VA
pays contracted exam vendors for every exam, even those that
were not necessary. In Fiscal Year 2023, about 2.4 million
exams were completed, a number that rose to approximately 3.2
million in Fiscal Year 2024. Contracted exam vendors were paid
for nearly 95 percent of those exams. In December 2024 report,
in the 2024 report, the VA Office of Inspector General (OIG) of
the Inspector General (IG) found that VA spent about $1.4
million on unnecessary exams from April through September 2023.
The total amount of wasted taxpayer dollars each Fiscal Year is
likely much higher. The OIG review did not cover the full
Fiscal Year or examine all types of claims of decisions, both
approvals and denials.
We have heard from OIG and the VA employees that
overdevelopment mistakes are due to an inadequate training.
Claims processors as well as confusing and inconsistent
guidance. To address overdevelopment, VA created an
Overdevelopment Reduction Task Force. This task force
recommended dozens of actions, including targeted quality
reviews, updating policy guidance, and increased training.
I look forward to hearing from VA today on the progress
made in implementing the Task Force's recommendations,
particularly I am interested in whether the VA has implemented
a plan to evaluate the effectiveness of its efforts using clear
result-driven metrics for success and I would like to hear
about any efforts VA is undertaking to further enhance its
strategies to decrease overdevelopment.
Finally, I look forward to discussing whether VA will
implement technology to ensure that every claims processor who
overdevelops a claim learns from that mistake. The National
Work Queue, also known as NWQ, electronically distributed the
major--the majority of VA claims workloads across all regional
offices (RO). The National Work Queue has largely decreased
decision wait times, thankfully. A key feature of the National
Work Queue is that when a claims processor defers a claim for
development, it is returned to the National Work Queue. The
National Work Queue often then routes the claim to a different
claims processor at another regional office for additional
action.
We have heard about cases where one claims processor after
another claims processor makes the same overdevelopment error
in the same veteran's claim. These repeated mistakes are so-
called avoidable deferrals, have resulted in months or years
long delays for veterans even before a claims processor
realizes that the development efforts were unnecessary. The
current system only notifies the most recent claims processor,
to my understanding, that they committed an overdevelopment
error. All the other previous claims processors who committed
the same mistake in the same claim are actually never notified,
that is what we need clarification on, and therefore do not
learn from that specific mistake.
November 2024 letter then Undersecretary for Benefits, Dr.
Josh Jacobs informed me that there are no technological
barriers preventing VA from notifying all claims processors who
have made the same overdevelopment mistake in a single claim.
Mr. Jacobs told me the VA would conduct a pilot study to
determine the value of additional functionality. I look forward
to hearing about the study, progress, and any findings under
the current Administration. Every veteran survivor deserves a
timely decision on their claim decisions. Wait times will
decrease if we can reduce or eliminate overdevelopment. I look
forward to hearing from our witnesses today about VA's efforts
to do so.
I now yield to the ranking member.
OPENING STATEMENT OF MORGAN MCGARVEY, RANKING MEMBER
Mr. McGarvey. Thank you, Mr. Chairman. Good afternoon,
everybody. Thank you all so much for being here today. You all
have heard me say this a million times. I am going to say it a
million more times. Everything we do on this subcommittee is on
behalf of our veterans. Everything. It is to serve our
veterans. Today, that means making sure that the VA systems
used to process disability claims for our veterans work the
best they can. It also means equipping and empowering the
employees who serve the veterans. We need them to be able to do
their best work without unnecessary limits or undermining their
importance to the system.
Unfortunately, this Administration continues to spread the
false message that VA employees are not dedicated to their
mission, that they do not have the veterans best interest at
heart. There is an email from U.S. Office of Personnel
Management (OPM) that castigated all Federal workers as low
productivity. It is simply not true. It is also hurtful. It
hurts morale at the VA, which ultimately affects the job
performance, which hurts our veterans, which is what we are
focused on in this committee, helping our veterans.
The Veterans Board of Appeals employees, the Veterans
Benefits Administration (VBA) employees, like those in my
regional office in Louisville, Kentucky, are highly dedicated
to their mission. Many are veterans themselves. They go to work
every day in a stressful, high-pressure environment and work as
hard as they can on behalf of the veterans they both serve and
sometimes served with. They are in systems where they are
forced to work in, and the systems fail. They are not given
adequate training. They are subject to arbitrary performance
metrics and sometimes arbitrary discipline and now even
unnecessary insults. All of that makes it more difficult for
them to do their job, which, of course, ultimately makes it
more difficult to serve our veterans.
I am interested today in exploring ways that we can improve
outcomes for veterans by making the job of these dedicated VBA
employees easier. The Administration's recent decision to end
collective bargaining agreements with the unions representing
these employees, it is a serious mistake. I think it is going
to harm both the employees at the VBA and the veterans they
serve. That is really important.
I think it is going to have an adverse impact on our
veterans because the unions are crucial to creating a workplace
that helps employees perform their best, delivering better
results for our veterans. They help employees feel more
invested in their work, and they offer better chances for
mentorship and personal growth. The public sector unions play
an important role in creating a higher quality training for
their members and providing important feedback to management
and policymakers about what is actually happening on the ground
in the organization. This means better retention rates. It
means lower wait time for benefits, and ultimately better
service for our veterans.
Contrary to belief, public sector unions do not stand in
the way of dismissing bad employees. In fact, they often
facilitate it. It is in their best interest to make sure that
all employees are doing their job well. Public sector unions
do, however, make sure an employee's dismissal is justified,
orderly, and most importantly, legal.
I am hopeful today that the Secretary will listen to this
committee and request an exemption from Trump's executive order
(EO), because these employees deserve all the rights afforded
to them under law and the Constitution to best fulfill their
mission and, of course, deliver the best possible service and
results for our veterans.
Thank you, Mr. Chairman. I yield back.
Mr. Luttrell. Thank you, Mr. McGarvey. Our lead witness
from VA is Mr. Kenneth Smith, Assistant Deputy Undersecretary
for Field Operations, as well as the Acting Executive Director
for Education Services for the Veterans Benefits
Administration. Mr. Smith is joined by Mr. James Smith, Deputy
Executive Director for Policy and Procedures. You guys related?
Mr. Smith. No.
Mr. Smith. No.
Mr. Luttrell. Just checking. Procedures and Compensation
Services. Sorry, man, I lost myself. I am sorry. For the
Veterans Benefits Administration. Mr. Smith is also joined by
Mr. Robert Orifici. Got it. We have been together long enough.
Executive Director for Benefits and Memorial Services for the
Office of Information and Technology. Today's witness panel
also includes Mr. James Swartz, sir, who is the president of
Local 2823 in the American Federation of Government Employees
(AFGE).
I asked that the witnesses on our panel please stand and
raise your right hand.
[Witnesses sworn.]
Mr. Luttrell. Let the record reflect that the witnesses
have answered in the affirmative. Mr. Smith, you are now
recognized for 5 minutes to deliver--Mr. James Smith, you are
now recognized. What is that? I am sorry. Mr. Kenneth Smith,
you are going to start us off with the Smiths. You are now
recognized for 5 minutes to deliver your opening statement on
behalf of the Department.
STATEMENT OF KENNETH SMITH
Mr. Smith. Good afternoon, Chairman Luttrell, Ranking
Member McGarvey, and members of the subcommittee, thank you for
the opportunity to discuss VA's efforts to increase efficiency
and process processing veterans disability compensation claims
through the National Work Queue and improvements brought by the
Overdevelopment Reduction Task Force. Joining me today are
James Smith, Deputy Executive Director for Compensation
Service, and Robert Orifici, Portfolio Director for Benefits,
Appeals, and Memorial Services, Office of Information and
Technology.
The Veterans Benefits Administration has undertaken
substantial efforts to enhance training and quality review
programs by focusing on high standards of performance and
continuous learning opportunities for VA staff. Today, I will
highlight three specific ways VA is better supporting our
employees and veterans.
The first improvement is enhancing the Exam Scheduling
Assistant, which helps employees correctly determine if an exam
or medical opinion is necessary. Originally launched in 2023,
this tool was refreshed last year through the most recent work
of the Overdevelopment Reduction Task Force. Exam errors
specific to overdevelopment have been one of the top categories
of error and delay, resulting in avoidable deferrals and
rework. Recent enhancements increase the tools used by 48
percent and contributes to a reduction in monthly errors cited
for exam overdevelopment. In Fiscal Year 2025, to date, these
errors have decreased by 7 percent over Fiscal Year 2024. VBA
will integrate this tool into the Veterans Benefits Management
System (VBMS), which we expect to launch in Fiscal Year 2026.
The second improvement involves training strategy. In June
2024, VBA launched interactive hands-on learning modules and
updated training content, including comprehensive lessons on
requesting exams. These efforts reinforce concepts through
interactive activities, ongoing assessments to gauge mastery of
the content, remedial training, and follow-up assessments for
those who need additional repetition. As recommended by a
recent OIG audit, VA added The Sergeant First Class Heath
Robinson Honoring our Promise to Address Comprehensive Toxics
(PACT) Act specific related medical opinion requirements to all
training products, ensuring employees are well trained to
address common disabilities. During VBA's Quality Standdown on
March 20th of this year, claims processors were provided
additional training and live instructor engagement activities
focused on ordering exams and medical opinions.
Third, VBA and the Office of Information Technology are
developing a solution to complete claims actions correctly the
first time through improvements to the Veterans Benefits
Management System. This upgraded functionality is being
designed as an error check for the employee, providing real
time feedback on potential errors before the claim is recalled
to the National Work Queue. This effort is aimed at reducing
instances of misdevelopment, while improving first touch
efficiency and reducing avoidable deferrals. This functional
enhancement is currently in development and is planned for
initial testing beginning in Fiscal Year 2026. On the topic of
avoidable deferrals, VA has recently completed preliminary data
analysis for a pilot study. The study aims to develop a
reporting solution for employees to receive feedback on any
claim they touched that resulted in an avoidable deferral. I
look forward to providing results to the committee on this
study and its impact on training and mentoring.
VA is also working on additional improvements to the
National Work Queue to support improved timeliness through
better workload management. These include advanced data
analytics and predictive modeling to prioritize claims in near
real time and distribute claims based on complexity, urgency,
and employees skill and experience to speed up the claims
process. These improvements will also allow employees to
request additional work in real time directly from the work
queue and promote supervisory focus on coaching and quality.
Together, these upgrades ensure claims are handled by the most
suitable staff, leading to a faster decision and continued
reduction of the claims backlog, and higher quality decisions
for veterans. This project is estimated for completion in
Fiscal Year 2026.
VBA remains committed to delivering the highest standard of
service to our Nation's veterans, their families and survivors.
While significant progress has been made, we recognize the need
for continuous improvement and adaptive--adapting to evolved
needs of those we serve.
Thank you for continued support and collaboration as we
honor our veterans' sacrifices. Mr. Chairman, this concludes my
statement. My colleagues and I are ready to answer any
questions you or other members of the subcommittee may have.
[The Prepared Statement Of Kenneth Smith Appears In The
Appendix]
Mr. Luttrell. The written statement of Mr. Smith will be
entered into the hearing record. Mr. Swartz, you are now
recognized for 5 minutes, sir.
STATEMENT OF JAMES SWARTZ
Mr. Swartz. Chairman Luttrell, Ranking Member McGarvey, and
members of the committee, on behalf of AFGE and National
Veterans Affairs Council (NVAC), I appreciate the opportunity
to testify today. My name is James Swartz, and I am President
of AFGE Local 2823 representing the Cleveland, Ohio Regional
Office. I am a U.S. Army Service-Connected Veteran and I have
the privilege of continuing to serve my fellow veterans, first
as an Registered Nurse (RN) at the Cleveland VA and then in VBA
for the last 23 years. On behalf of over 320,000 VA employees
AFGE represents, including thousands of claims processors. It
is a privilege to offer AFGE's views on the National Work Queue
training and how VBA can enable employees to more efficiently
and effectively process veterans' and the beneficiaries'
claims.
VA should modify the National Work Queue so that a claim
remains within the same regional office for the duration of its
processing. Variations between regional offices can cause
claims processors from different ROs to misunderstand each
other's work, resulting in a correct claim being unnecessarily
deferred or delayed. Furthermore, by keeping a claim in a
single regional office, managers have more control to send
claims back to the original Veterans Service Representative
(VSR) who wants worked on it. This would allow the VSR to learn
from this error and not repeat it. This would also let the VSR
and our Rating Veterans Service Representative (RVSR) who are
already familiar with the claim to efficiently address follow-
up work, saving other employees from wasting time to
familiarize themselves with a new claim.
If VBA, despite record production and quality from
employees while working from home during COVID-19 pandemic, is
going to require claims processors to report to the regional
office, why continue to shuffle work throughout the country and
not instead leverage employee ability to collaborate with the
colleagues sitting next to them?
As Congressman Self asked about the last time I testified,
despite the claims backlog, one of the most consistent
complaints from the claims processors is they do not have
enough work to meet the performance metrics and must waste time
asking for more work. The reason for this problem is the
internal controls VBA has put on the National Work Queue.
To address this, AFGE recommends, first, the National Work
Queue should automatically provide claims to individual claims
processors work queue when they are out of cases to develop or
rate. Second, claims processors should have a limited ability
to temporarily hold onto the claim before it is retracted by
the National Work Queue. Having the claim stay within one
regional office for its duration would avoid delays and give
ROs more control over their workload. It would also allow
secondary claims to be associated with the primary claim and
worked on simultaneously. Third, the National Work Queue must
better filter automatic ready-to-rate claims, ensuring
employees do not waste time on cases that are not ready to
rate. Fourth, VBA should program the National Work Queue so
employees who have previously worked on the claim have the
claims returned to them. This would allow claims processors to
learn from any mistakes that were previously made and improve
efficiency and quality.
New employees do not understand the claims process or VA
lingo that is critical for employees to do their job. This is
an easy problem to fix. All training should require hands on
experience using the tools employees will actually use.
Training must also focus on mastering the basics, including
learning the claims process, VBA terminology, and what a claim
looks like. AFGE urges VBA to reorder its curriculum to allow
instructors to reference the material that was just taught,
reinforce the concept, and use this to teach higher level
concepts. VBA must also improve PACT Act training as Talent
Management System (TMS) self-reviewed courses are ineffective,
especially considering constant updates to the Standard
Operating Procedure (SOP) and manuals that are not reflected in
the training.
Finally, on behalf of AFGE and NVAC partners who have long
worked with this committee to help improve the VA and its
delivery of benefits in health care to our Nation's heroes, I
respectfully urge you to ask Secretary Collins to use the
authority granted to him by President Trump's executive order
to certify VA employees, including the employees under the
jurisdiction of the subcommittee at the Veterans Benefit
Administration, National Cemetery Administration, and the Board
of Veteran Appeals, are not involved in national security and
are, in turn, exempt from the executive order.
The rights guaranteed in our collective bargaining
agreement are critical to our ability to support the VA's
mission and better serve veterans and their families. VBA is
two generations of employees, both the mentors with
institutional memory who are close to retirement and the next
generation who are just beginning their journey of caring for
veterans. Within 5 to 10 years, this knowledge will be lost
forever if there are no exemptions made, combined with the
proposed rifts. AFGE and NVAC stand ready to work with the
House VA Committee and VBA to address these issues.
Thank you and I look forward to your questions.
[The Prepared Statement of James Swartz appears in the
Appendix]
Mr. Luttrell. The written statement of Mr. Swartz will be
entering into the hearing record. We will now move to
questioning. Mr. Smith, Kenneth Smith, Mr. Swartz seems like he
nailed it right on the head. Now, this is kind of the
conversation you and I have been having the past couple of
years.
Can we have a, not totally granular, but dive into the
National Work Queue 2.0? You mentioned first touch efficiency.
I think that is brilliant. Then what Mr. Swartz said, how a
specific claim will return to a particular Veterans Service
Organization (VSO) before it is--so it can be completed or
repopulated into the work queue and then out to another
regional office.
Mr. Smith. Thank you for the question. We are working on
new capability to focus on direct feedback to employees at the
development action. This is a solution that we have been
thinking carefully about since our conversations over the last
year, year and a half. The idea here is to provide an error
check right after they have completed their actions and before
it returns to the National Work Queue to prevent delay on that
claim. This is part of an interactive discussion between my--
VBA and the Office of Information and Technology, who is
working on that solution right now.
Mr. Luttrell. As we are doing our best to inform anyone
that they have made a mistake from the top down, what are we
doing from the bottom up as far as training and readiness is
going, so the mistake window is closed?
Mr. Smith. Yes. I mean, we have completely revamped our
training. Mr. Smith and his team have been working diligently
on that to build in more training about exams, to make sure
that we order the right exams the first time and not
overdevelop. It has been added into all of our existing
training products as well as our most recent Quality Standdown,
where we took our entire workforce offline for a day to focus
on specific training needs.
Mr. Luttrell. Mr. Swartz mentioned that some of the VA
employees are saying there is not enough work for them, which I
find that--I have heard that myself from VA employees. I would
like to hear your response and I--okay, so you are going to get
into the National Work Queue thing. I got it. All right.
However, if we do have certain employees at regional offices
say there is nothing here for me. We have a miss somewhere.
Mr. Smith. Yes, sir. There are 918,000 veterans waiting for
decisions in the National Work Queue right now.
Mr. Luttrell. Is that number----
Mr. Smith. I----
Mr. Luttrell. That number is down?
Mr. Smith. It is. Since over the last year we have dropped
it almost 6 percent.
Mr. Luttrell. Six percent?
Mr. Smith. Mm-hmm.
Mr. Luttrell. Okay.
Mr. Smith. The very fact that we do not have any work,
there are two potential reasons for that that I can understand.
You know, one is it has not been assigned to the employee or
they have depleted all the work in their queue. That is why we
want to be able to allow them to pull claims in when they are
ready and then have us, have the National Work Queue push
claims to them that is matched to their experience and
training. Newer employees that are trained on a smaller subset
of disabilities or types of claims get disability claims that
they can work until they are fully trained and able to do all
of them. More experienced staff can handle the more complex
claims.
Mr. Luttrell. I understand this correctly, now a claim will
move from the National Work Queue into a regional area. A VA
employee will be able to pull that claim without having a
supervisor load up their desktop more or less, and the
supervisor providing, I guess, oversight and training. An
employee can, can move as much as possible. I am sure there is
a baseline somewhere. It is like, hey look, you are--your
minimum is this weekly, monthly.
Mr. Smith. My expectation, and this is still, we are still
working on the exact development and solution with Mr.
Orifici's staff. The concept that we are operating under is
that we will be able to distribute enough claims every day,
prospectively, to keep people busy. Then if they actually run
out because things are not ready for them, that they will be
able to request additional work.
Mr. Luttrell. I know we do not have a stat yet on--I am
going to walk that one back. I want to think about that one for
a second. Sir, Ranking Member, I will yield to you for your
questioning.
Mr. McGarvey. Thank you, Mr. Chairman. Mr. Swartz, I want
to dig in a little bit about the recent executive order and the
collective bargaining agreement that AFGE negotiated with VA.
Aside from just being a gross breach of good faith, it also has
some very real practical and detrimental consequences on the
day-to-day work of those who are involved in processing claims.
Again, that means our veterans. Anything that harms our
frontline employees' ability to do their job by definition
harms their ability to serve the veterans who are at the heart
of VA's mission, who are at the heart of the mission of this
committee.
Mr. Swartz, ask you some questions. To your knowledge, has
the Secretary submitted a request for an exemption to the
collective bargaining EO for VBA employees?
Mr. Swartz. No, sir.
Mr. McGarvey. Thank you. Mr. Swartz, can the union members
at VA collectively bargain for wages or promotions?
Mr. Swartz. No, sir. That is banned by law, I believe.
Mr. McGarvey. Okay. Can the union collectively bargain
performance standards surrounding either quality or timeliness
of claims processing?
Mr. Swartz. No, sir.
Mr. McGarvey. When was the last time the union workers at
VA went on strike?
Mr. Swartz. Never. It is against law.
Mr. McGarvey. Perfect. Can the union collectively bargain
for more or better training?
Mr. Swartz. No, sir. I do believe that is where the union
would be very beneficial for both the employees, the VBA or VA,
and also for the veterans. Most of us are workers ourselves. We
are aware of what is going on. We do the work, we talk to the
first line employees, and more often they will come to us and
let us know what their training needs are. Many of them are
afraid to actually go to managers or supervisors. We have even
worked with a lot of supervisors when employees are running
into trouble so that we can work with the employees to get them
where they need to be.
Mr. McGarvey. What would you say is the biggest impediment
to frontline employees operating more efficiently with higher
quality? How do you think AFGE can help remedy that?
Mr. Swartz. The number one issue would have to be training,
and that is where the VA would be, or, I am sorry, the unit
would be able to work with the VA in order to establish what
training is needed and to help the employees be able to get to
their--get these training needs met when it becomes an issue,
before it becomes a problem.
Mr. McGarvey. Just looking at this, how does the lack of a
union with collective bargaining rights impact the ability of
frontline employees to do their job well and better serve
veterans?
Mr. Swartz. I would say one of the biggest things has
probably have to do with moral, the moral impact that it would
have. The employees will no longer have a voice. They will no
longer feel comfortable or competent to be able to go to the
agency and discuss what their training needs are or discuss
even what some of the roadblocks are in the way of them
performing the mission.
Mr. McGarvey. Is VBA planning to consult frontline
employees in development of new technology modules?
Mr. Swartz. Not that I am aware of.
Mr. McGarvey. Okay. What about the training content?
Mr. Swartz. Again, not that I am aware of. I have been
fortunate enough at, I hate to say it, at my regional office,
but I have been able to work with management to get employees
some of the additional training necessary.
Mr. McGarvey. For Mr. Kenneth Smith, I will just ask you
those exact same questions. Is VBA planning to consult
frontline employees in development of new technology or
training modules?
Mr. Smith. Usually management develops the solutions and
then we brief the union when it is time to implement.
Mr. McGarvey. I would just suggest from being in the
private sector and other things, getting the input from the
people who are actually doing the work on the ground before you
develop the training is a best practice. What about the
training content, is it the same thing?
Mr. Smith. I believe that there--and I will ask Mr. Smith
to weigh in on this. I believe there are union members on the
training team.
Mr. Smith. That is correct. Not only are they on the
training team, they develop the content and then also Subject
Matter Experts (SMEs) from the field, more often than not are
labor BUEs. They are actually the ones providing the training.
Mr. McGarvey. Again, we want the best training. We want the
best employees. This is what helps our veterans. Thank you guys
so much.
Mr. Chairman, I yield back.
Mr. Luttrell. Thank you, sir. Mr. Smith, did the
Overdevelopment Reduction Tax Task Force, was that disbanded
last year?
Mr. Smith. I would not say disbanded, sir. It completed
work at the end of July. We are working right now on some
additional initiatives. Such as, we are collaborating with the
Board of Veterans' Appeals and Office of General Counsel to
take a look at end-to-end automation and process and procedural
efficiencies.
Mr. Luttrell. Did it perform its functionality as it should
have? It seemed like that was a pretty short window.
Mr. Smith. Yes, sir. They made more than 50 manual updates
to streamline and clarify guidance as well as promoted and
executed some enhancements to the exam scheduling assistant to
make it more--a little better for employees.
Mr. Luttrell. That is onboard and running.
Mr. Smith. It is up and running, but it is a standalone
tool. What we are doing right now is building that into VBMS so
that the claims processors do not have to lead the VBMS
environment to use it.
Mr. Luttrell. Besides updating the VBA manual on March 10,
what else is the VA doing to ensure claims processors
understand the long-standing rules for when to schedule an
exam?
Mr. Smith. That is core to our training. All of our
training content reinforces the requirements for training for
ordering exams and medical opinions. We have done that through
our Overdevelopment Reduction Task Force. Those recommendations
reinforce that leading to a 7 percent decrease in
overdevelopment errors.
Mr. Luttrell. You mentioned 7 percent reduction off of the
gross number. What is projection for this year and what was
our--did we break a record last year? Or last year--in February
for disability claims?
Mr. Smith. Yes. We completed more than a million claims
earlier this year than ever before.
Mr. Luttrell. Job well done.
Mr. Smith. Thank you.
Mr. Luttrell. I will share that with everybody I know. How
are we looking for what month is it? April, May, June? How -
what is the projection downstream?
Mr. Smith. We are looking--right now we are running eight
and a half percent ahead of where we were this time last year.
We are looking to complete more than 2.5 million claims this
year.
Mr. Luttrell. What is our total that are outstanding? I
mean, eventually I would assume we are going to run out of
veterans.
Mr. Smith. Well----
Mr. Luttrell. If we are working at this rate, seems like. I
probably should not say it like that. I got 40,000 veterans who
will kick my butt for saying that. I did not mean that in a bad
way. What I meant was, for the record, what I meant was
eventually all our veterans will be whole.
Mr. Smith. Yep. We continue to receive about 10,000 new
claims a day. Our inventory right now is 918,000. We have been
fortunate with some high productivity. We have been completing
north somewhere between right around 11,000 claims a day to
help us decrease the inventory and get ahead of the backlog as
well.
Mr. Luttrell. Okay, well. Outstanding. Before I move on,
Mr. Smith, do you have anything you would like to add? I would
hate for you to come all the way--we are having markup in
multiple committees currently today. Obviously, that is why--
the ranking member and I are the only ones here. Mr. Smith, I
am not going to let you come all the way to DC. and not say
anything.
Mr. Smith. No, I appreciate the opportunity. I would like
to circle back to the Overdevelopment Task Force. In addition
to what Mr. Smith shared some of the feedback not only from,
you know, our partners across the different business lines, but
our SMEs from the field to include bargaining unit employees
(BUEs), was that the class size was too large. We shrunk the
class size. We focused on four phases of a training process.
Planning, design development, implementation, evaluation, or
the Kilpatrick Model. We are focused on making data-driven
decisions and updates to the training based on feedback, the
assessments that the employees complete themselves as well as
data that has gleaned from quality reviews. We are committed to
continuous process improvement with the goal of putting
veterans first in every decision made.
Mr. Luttrell. Mr. Orifici.
Mr. Orifici. Thank you for the opportunity. We are
extremely excited about the work that we are doing in support
of VBA and claims process. We are utilizing a lot of the
current technologies including Artificial Intelligence (AI) to
help us get ahead of the claims process.
Mr. Luttrell. Are you where you need to be or is the VA
where they need to be in the AI space, since it is forever
changing? I would recommend you keep us very well read on if we
are slowing so we can get ahead of it.
Mr. Orifici. No, we are definitely leaning into it. We are
utilizing it to its most. We are very excited about the
interactive assist that we have for claims with helping them to
avoid deferrals and help them make the right decisions. This
will also tie back into ordering the right exams when they are
needed and not ordering exams when they are not.
Mr. Luttrell. Mm-hmm.
Mr. Orifici. We have a lot of very interesting pilots
coming up that we are working with VBA on. That should yield a
lot of benefits when it comes to making the right decision the
first time versus having to defer back to correct later on.
Mr. Luttrell. Okay, thank you. There will always be
something that populates. There will always be a problem set
that exists. The VA is such a wonderful working machine. Right?
I mean, I say that wholeheartedly. It has its problems. It
does. We should forever be changing in order to keep up with
the wants and needs of our veterans' space. As we move into, as
our older generations, we are moving into the younger
generations, our generation of war fighters are coming into the
VA, and there are a lot of us. Then, you know, it pains me to
say this, but we are always on the threshold of activation
again.
If we do have to go to another theater of war, it will
populate more and more and more of us. The VA, as hard as we
work, will always have to work harder every single day. Every
day, I am sure you do the same thing. Every day I wake up and I
walk into the--I look in the mirror, I was like, it is not
about me. It is about everybody I represent. Guess what,
gentlemen? You represent the most cherished asset we have, and
that is our veterans that allowed us to do the things that we
do today. Okay?
Ranking Member, you got any closing remarks?
Mr. McGarvey. Thank you, Mr. Chairman. I echo those
remarks. I thank you for your service and thank you all for the
service you perform, particularly on behalf of our veterans,
the men and women who are putting on a uniform, willing to
sacrifice everything to keep us safe and keep us free. What I
am going to ask you all to do is on this committee, we actually
do our best to work together because we understand the mission
of this committee is to serve our veterans. Make sure you got
the best management, make sure you got the best labor, and that
everybody is getting the training they need, and that everybody
has access to the tools they need and the morale they need, the
retention that we need to keep people there to keep these
claims going forward, because that is what is going to help our
veterans out. Hope you all can continue to do that good work,
because it is going to take care of the men and women who took
care of us.
Mr. Chairman, I please ask unanimous consent to enter into
the record the following letter to Secretary Collins, from Rep.
Takano, yourself, Senator Blumenthal, and 126 other members of
the House and Senate condemning the Trump Administration's
decision to obviate the collective bargaining agreements,
bargaining rights of Federal employees, and urging the
Secretary request waiver from those requirements.
Thank you.
Mr. Luttrell. Without objection. Thank you again,
gentlemen, for coming today. I ask unanimous consent that all
members have 5 legislative days to revise and extend their
remarks and include extraneous material. Without objections, so
ordered. This hearing is adjourned.
[Whereupon, at 2:18 p.m., the subcommittee was adjourned.]
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A P P E N D I X
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Prepared Statements of Witnesses
----------
Prepared Statement of Kenneth Smith
Good morning, Chairman Luttrell, Ranking Member McGarvey, and
Members of the Subcommittee. I appreciate the opportunity to appear
before you today to discuss VA's efforts to improve efficiency in
Veterans' disability compensation claims processing through the
National Work Queue (NWQ), and the efficacy of VBA's quality assurance
and training programs resulting from the Overdevelopment Reduction Task
Force (ODRTF). Joining me today are James Smith, Deputy Executive
Director of Compensation Service, and Robert Orifici, Executive
Portfolio Director for Benefits Appeals and Memorial Services, Office
of Information and Technology.
VA is committed to providing outstanding customer service to our
Nation's Veterans, their families, and survivors, and we are steadfast
in our commitment to timely and accurate decisions on Veterans'
disability compensation claims. VBA has a robust training and quality
review program holding employees, regional offices (RO), and program
offices to a higher standard for producing quality claims decisions
while also promoting continuous learning and performance improvement.
We appreciate the Subcommittee's interest in this topic, and I know we
share the same goal of collaboration and continuous improvement.
Over-Development Reduction Task Force
On January 31, 2024, ODRTF's second phase (ODRTF 2.0) kicked off
with a focus on improving the claims examination process. The task
force put an emphasis on contract examinations, utilization of private
Disability Benefits Questionnaires (DBQ) submitted by Veterans,
utilization of the Examination Scheduling Request tool, and
effectiveness of automated examination ordering. It also explored
opportunities in policy, processes, and technology to eliminate over-
development.
When ODRTF 2.0 concluded in July 2024, VA implemented numerous
recommendations in several areas including improvement of the private
DBQ submission process; guidance to field employees on appropriately
requesting examinations; and employee training to assist claims
processors in scheduling more informed, intentional, and accurate
requests for disability examinations and medical opinions.
One of the recommendations that VBA implemented were improvements
to the Exam Scheduling Assistant (ESA). This tool provides claims
processors with a series of questions for each claimed disability and
helps determine whether an examination or medical opinion is warranted.
VBA is in the process of integrating the web-based ESA tool into the
Veterans Benefits Management System (VBMS) so that claim data can be
auto-populated, reducing duplication of work and increasing the
accuracy of examination decisions. The integrated tool will continue to
present the claims processor with a series of questions to aid in claim
development. The anticipated date of release of the integrated tool is
Fiscal Year (FY) 2026.
Additionally, since June 2024, VBA has made procedural changes to
clarify and emphasize that examinations are not required when there is
sufficient evidence of record to decide the claim. VA regulations
direct decision-makers to render a decision without the need of further
examination or development, if the medical evidence of record is
sufficient. This includes accepting private DBQs when sufficient, which
avoids scheduling unnecessary exams. VA is continuing to guide claims
processors on this concept as another update to VA's procedures manual
relating to medical evidence sufficiency was just published on March
10, 2025.
Training and Quality Initiatives
In June 2024, VBA began efforts to modernize training for all
disability compensation claims processors. This program has
specifically focused on reducing over-development in medical opinions
and examinations - streamlining when, why, and how they are ordered.
These lessons emphasize hands on learning and reinforcement of concepts
through interactive and engaging activities, ongoing assessments to
ensure learners are mastering the content, and remedial training and
follow-up assessments for those who fail to grasp the concept the first
time it is assessed. Some of the specific training courses provided in
support of minimizing over-development include courses on preventing
deferred rating decisions in the claims process, identifying the need
and sufficiency of VA examinations, reviewing DBQs to determine if a
medical opinion is necessary to decide a claim versus when it can be
decided based on the evidence of record, and a renewed training on the
duty to assist requirements for our Rating Service Representatives who
render decisions on Veterans' claims for compensation benefits.
When training newly hired claims processors, VA emphasizes the
negative impact over-development has on claims timelines. How, when,
and whether to order examinations consistent with regulatory guidance
are addressed in several courses during initial claims processor
training. The courses emphasize the impact of 38 C.F.R.Sec. 3.326 -
specifically, that medical evidence accompanying a claim, whether
submitted by the claimant or received from a Federal records custodian,
might render a claim ready for decision without the need of further
examination or development. This scenario is frequently seen with cases
of active, presumptive cancer, or claims for increase for total joint
replacement - an examination would provide no new information beyond
what is already available in the medical records, so the claim should
be decided immediately.
Examination and medical opinion training courses have also been
updated to include the most recent guidance on requesting evidence,
sufficient examinations, and Sergeant First Class Heath Robinson
Honoring our Promise to Address Comprehensive Toxics Act of 2022 or
PACT Act-related claims and toxic exposure risk activity opinions.
These concepts are reinforced throughout training with knowledge checks
and instructor guidance.
Additional training is provided to claims processors on a recurring
basis for topics such as the different types of medical examinations
and opinions and in which scenario each is required or not required to
grant a claimed issue. An important part of this training is
specifically focused on preventing the ordering of additional
development for examinations and medical opinions when the evidence of
record allows the claimed issue to be resolved in the Veteran's favor.
This information is laid out and reemphasized throughout the training
program for new claims processors.
In June 2024, VBA hosted the first ever VBA-wide Quality Standdown,
highlighting the Agency's commitment to the importance of high-quality
actions and positive work experience. This provided claims processors
with targeted instruction on medical exam requests and the rework
process. In the post-event survey, with 77 percent of employees
reporting positive sentiments with improvements noted in 3 month
rolling quality. In Fiscal Year 2025, VBA plans to host regular events
collaborating with the Board of Veterans' Appeals and Office of General
Counsel to further improve measurable outcomes and engage employees in
content directly related to accuracy trends.
VA acknowledges that there is always room for improvement, however
VBA's quality data shows that monthly errors cited for examination
over-development in Fiscal Year 2025 to date has decreased by just over
7 percent from Fiscal Year 2024. VBA achieved this while the average
number of claims processors on production increased by nearly 11
percent. Additionally, in disability compensation rating claims, 3-
month issue-based accuracy improved from 91.5 percent at the close of
Fiscal Year 2024 to just under 93 percent at the close of January 2025.
This portrays that the changes VBA implemented to improve quality
assurance and training programs are having a positive effect. VBA will
continue to find ways to improve.
VA's commitment to continued process improvement of quality
programs has been further strengthened by additional safeguards that
have been built into the processing software used to develop and decide
claims for benefits. For example, modifications were made to the
examination process by updating a tracking indicator in the VBMS system
to clarify the status of medical examinations and what additional
evidence, if any, may be required. This allows claims processors
involved with the claim to quickly surmise the status of the claim and
to determine what other development actions are required to decide the
claim.
Implementing VA Office of Inspector General (OIG) Recommendations
In the OIG Report, ``Staff Incorrectly Processed Claims When
Denying Veterans' Benefits for Presumptive Disabilities Under the PACT
Act,'' \1\ OIG made a process recommendation and a systems
recommendation. VA has made significant progress in addressing both. As
previously noted in this testimony, VBA is scheduled to implement the
web-based Exam Scheduling Assistant (ESA) tool within the VBMS in early
Fiscal Year 2026. However, the ESA tool has been available as a stand-
alone, web-based tool for claims processors since November 2023, in
addition to RO guides developed by the Medical Disability Examination
Office such as the ``Exam Scheduling Request Reference Job Aid'' and
``Medical Opinion Guide.''
---------------------------------------------------------------------------
\1\ https://www.vaoig.gov/reports/review/staff-incorrectly-
processed-claims-when-denying-veterans-benefits-presumptive
---------------------------------------------------------------------------
Transformative changes are currently being implemented in the
National Work Queue (NWQ) system, as well as how the NWQ team trains
the field on workload management, which will impact the efficiency of
claims processing within VBA. VBA has implemented training to address
workload management issues, to include local auto-assignment rules.
Supervisors have provided positive feedback that the training has
significantly helped, and they also bring that knowledge back to their
RO peers.
While the December 2024 OIG report highlighted inconsistencies in
claims processing, VA is actively addressing these issues by refining
the Adjudication Procedures Manual and enhancing examination tools.
Most recently, on March 10, 2025, VBA published a revision to the
Manual to add a note on the threshold for evidence of a current
disability-or persistent or recurrent symptoms of disability-for the
purpose of determining whether to request an examination and/or medical
opinion and to cross-reference similar principles discussed in other
portions of the Manual. Based on this progress, VBA has requested
closure of the related recommendation and continues to work toward
closure of the remaining recommendation.
VA is committed to continued process improvement for processing
PACT Act claims and is implementing OIG's recommendations. VA is
continuing to update the Manual on when personnel should request
medical disability examinations and opinions. Additionally, VA is also
working on enhancing systems and tools involving the examination
process.
National Work Queue Initiatives and Improvements
National Training and Supervisory Workload Management Training (SWMT)
In August 2023, NWQ conducted national training for all regional
offices, with over 600 claims processing managers attending, focusing
on local rules and deferral routing. This content has since been
incorporated into the SWMT, launched in February 2024. SWMT is designed
to equip new supervisors with the principles and best practices for
workload management. To date, 300 supervisors have benefited from this
training. Additionally, NWQ offers personalized consultations with RO
managers to enhance their understanding and application of local
workload routing rules.
NWQ 2.0 and Enhancements
NWQ 2.0 will represent a significant leap forward in VBA's claims
processing capabilities. One of the areas of concern raised by Congress
during a previous oversight hearing and confirmed by an internal ``red
team'' is the routing of work back to an employee who previously worked
on a claim. The current system, which utilizes Prior Assignment Routing
(PAR), has limitations, and does not always ensure that the claim
reaches the actual claims processor who previously worked on it. To
address this, VA has developed requirements for a new approach to
replace PAR, allowing for claims to be routed back to the employee
based on the last creditable transaction. VA is taking this one step
further and is carefully evaluating other approaches to implement
themes from the ODRTF while also reducing missed development. This
targeted approach will is expected to improve the first touch
efficiency and reduce avoidable deferrals, while still maintaining a
routing process to get the claim back to the last person who took
action on the claim.
Another key improvement in NWQ 2.0 is the introduction of a
``pull'' capability to allow a claims processor the ability to take the
next claim to be worked out of a dynamically optimized list of claims
pending assignment. Through this capability, claims processors will be
``badged'' with attributes, including experience level and proficiency
levels for specific categories of claims. When the employee is out of
work, they may request an additional claim, and the system will
automatically assign a claim that meets their competencies. Eventual
functionality will allow employees and their supervisors specific,
actionable feedback for additional training, while ensuring that claims
requiring special handling are directed to claims processors who are
both trained and qualified, thereby enhancing the efficiency and
accuracy of our service to Veterans.
VBA and the Office of Information and Technology (OIT) are
currently working to define requirements to achieve outcomes for both
reduction in erroneous development, the ability to leverage the prior
claims processor's expertise as well as provide feedback on errors if
subsequent development is necessary. This functionality will be
released incrementally, with the first deployments starting in Quarter
4 of this fiscal year. As functionality becomes available, VBA and OIT
will collaboratively confirm that the functionality is working as
intended and adapt requirements to ensure VBA has the capability needed
to distribute claims effectively.
Deferrals
The deferral process is a critical component of VBA's commitment to
quality and employee development. Deferrals are a mechanism for
employees working later stages of the claims process, to ensure the
completeness and accuracy of claims processing. It allows for mentoring
and constructive feedback, particularly for junior employees. When an
employee completes all required actions, they are certifying that the
work done is accurate and is ready for the next action by subsequent
claims processors to complete the claim. The most important movement of
a claim is the movement from evidence development to the decision
phase. In this scenario, if the decision-maker cannot make a decision
due to a misstep in evidence development, they will issue a deferred
decision and direct additional action be taken to remedy the issue.
This type of deferral may be categorized as either avoidable or
unavoidable. An avoidable deferral is an error in workmanship, while an
unavoidable deferral typically arises when new evidence has been
introduced subsequent to the last action. This process is not unique to
NWQ; it is an electronic adaptation of VBA's longstanding practice.
Avoidable deferrals are routed back to the last employee who
handled the claim for correction. This reflects a simple accountability
framework: employees are accountable for certifying the claim is ready
for a decision and should only certify claims for decision when they
have personally reviewed and have ensured that all necessary actions
have been taken. This fundamental management determination and process
ensure accountability and are longstanding principles that are hard
coded into VBMS. As of February 2025, 99 percent of all avoidable
deferrals were being routed back to the RO and 92 percent were routed
to the specific employee that last worked the claim in the prior claim
cycle.\2\
---------------------------------------------------------------------------
\2\ Deferrals may not route back to the previous employee if the RO
has the avoidable deferral routing turned off for specific employees
due to a new work assignment.
---------------------------------------------------------------------------
Supervisors play a crucial role in monitoring deferral frequencies
and developing plans for improvement. As part of recent national
events, such as the Quality Standdown and SWMT, supervisors have
received training on new tools to evaluate deferral trends and errors
trends. These tools include the Deferral, Error, and Transaction
Dashboard which compiles six reports into one easy to use tool, for
reviewing deferral data and recommending appropriate remedial training.
This report also houses all errors in one report, providing a breakdown
of errors by body system and claimed condition. These tools will allow
VBA to make data driven decisions to enhance training and drive quality
improvements.
VBA is taking a data driven approach to construct a pilot for wider
communication of a claim's deferral. VA's duty to assist often requires
more than one review in the development process. While VA is working to
ensure these claims are routed back to the same claims processor and
has made substantial improvements in this area, employee leave and
capacity may require assignment to another claim's processor for
subsequent action. While the deferral process assigns accountability
for full and complete evidence development to the last employee to work
the claim in the development cycle, VBA does recognize the potential
for feedback to the claims processor(s) who worked on the claim
upstream from the final certification of completeness. This feedback
would be focused on training and awareness of the need for quality at
each step of the process, with the intended effect of constructive
supervisor-employee discussions and continuous improvement. Available
data will be evaluated and shared with RO supervisors to determine the
utility of the feedback, which is in addition to existing feedback from
VBA's formal quality management process.
OIT and VBA are also evaluating other efforts to prevent deferrals
before they occur. One area of exploration will use Artificial
Intelligence (AI) and machine learning to analyze a claim, reference
policy manuals and user training materials, and provide guidance to
claims processors on which actions should be taken. These efforts are
using historic claims and deferrals to train AI models to better
understand what steps will be needed to lead to the correct outcomes
the first time. VA plans to begin a small pilot on this and other
efforts by the end of this fiscal year.
Conclusion
VA remains committed to identifying areas where we can improve our
systems and processes to increase the efficiency and quality of
benefits that we deliver to the Nation's Veterans. We will continue to
leverage internal quality reviews, adapt our training programs, and
continue advancements in NWQ 2.0 to ensure that all claim processors
are equipped with the best tools to complete our sacred mission and to
uphold President Lincoln's promise to care for those who have borne the
battle and for their dependents. Mr. Chairman, this concludes my
statement. We thank the Committee for your continued support of
programs that serve the Nation's Veterans and look forward to working
together to further enhance delivery of benefits and services. My
colleagues and I are prepared to respond to any questions that you or
other members of the Subcommittee may have.
Prepared Statement of James Swartz
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Statements for the Record
----------
Prepared Statement of Disabled American Veterans
Chairman Luttrell, Ranking Member McGarvey and Members of the
Subcommittee:
DAV (Disabled American Veterans) is grateful to provide a statement
for the record for this oversight hearing titled, ``Examining VA
Efforts to Decrease Delays in Veterans' Disability Compensation
Claims''.
DAV is a congressionally chartered and Department of Veterans
Affairs (VA) accredited veterans service organization. We provide
meaningful claims support free of charge to veterans, family members,
caregivers and survivors.
To fulfill our service mission, DAV directly employs a corps of
benefits advisors, national service officers (NSOs) and transition
service officers (TSOs), all of whom are themselves wartime service-
connected disabled veterans, at every VA regional office (VARO) as well
as other VA facilities throughout the Nation, including the Board of
Veterans' Appeals (Board). During 2024, DAV filed 561,358 claims for
over 1.5 million specific injuries and illnesses on behalf of thousands
of veterans, resulting in more than $30.4 billion in earned benefits
for veterans and their families.
We currently provide representation for nearly 250,000 pending
claims and appeals before the Veterans Benefits Administration (VBA).
Based on over a century of direct experience, we are pleased to provide
our insights and concerns related to the significant issue of
overdevelopment within the VA claims and appeals processes. This issue
directly affects the efficiency of VBA and the well-being of millions
of veterans who rely on timely access to their earned benefits.
Our testimony outlines the significant problems with
overdevelopment in several areas, which include feedback from our
service officers; claims related to the PACT Act; military sexual
trauma (MST); and disability benefits, as well as appeals under the
Appeals Modernization Act (AMA) and DAV's recommendations.
Overdevelopment, characterized by redundant and unnecessary
requests for additional evidence delays decision-making, creates
inefficiencies and imposes undue burdens on veterans. Additionally, the
implementation of the Veterans Benefits Management System (VBMS) and
the National Work Queue (NWQ) have contributed to challenges in
overdevelopment despite their intended purposes of streamlining the
claims process.
Examples of overdevelopment noted by our service officers
illustrate the broader systemic inefficiencies within the VA that
continue to hinder the timely and accurate resolution of claims and
appeals. For example:
Improper indexing of evidence in VBMS results in
unnecessary efforts to develop evidence already present in the
claimant's record.
VA claims processors that initiate examinations for
conditions unrelated to Toxic Exposure Risk Activity (TERA) leads to
wasted resources and unnecessary processing steps for TERA claims.
VA requests for additional examinations despite claimants
providing DBQs completed by private physicians results in delaying the
veteran's access to benefits.
The VA's statutorily required duty to assist is a foundational
obligation that requires the agency to assist claimants in gathering
relevant evidence to support their claims. Unfortunately, unclear and
inconsistent communication regarding the duty to assist has contributed
significantly to overdevelopment. Claimants often receive vague or
redundant notifications requesting additional evidence without
sufficient guidance on what is needed. This ambiguity results in
repetitive submissions, unnecessary delays, and excessive evidence
gathering, which burden both claimants and the VA system. Notifications
intended to update claimants on claim statutes frequently lack detail,
leaving claimants uncertain about next steps and prolonging the process
further.
The severity of the overdevelopment problem is fully displayed in
the 2024 Office of Inspector General (OIG) report titled, ``Staff
Incorrectly Processed Claims When Denying Veterans' Benefits for
Presumptive Disabilities Under the PACT Act'' (Report Number 24-00118-
01), which identified critical systemic issues in PACT Act claims
processing. Claims processors often requested unwarranted examinations
and medical opinions, even for conditions presumptively linked to
service. These unnecessary actions caused delays and incurred $1.4
million in avoidable expenditures over 6 months. Underpayments totaling
$56,700 were identified for improperly denied claims, along with 870
potential errors affecting veterans' benefits. Examinations containing
inadequate or conflicting information were not sent back for
clarification but were prematurely used to deny claims, further
exacerbating delays and appeals.
Additionally, the OIG report indicated that the VA had an
overdevelopment-reduction task force and the Deputy Under Secretary for
Policy and Oversight stated that overdevelopment is expensive and time-
consuming and has been a known problem for years.
Another area that has been plagued with systemic inefficiencies and
overdevelopment are claims dealing with MST. According to the 2021 OIG
report, ``Improvements Still Needed in Processing Military Sexual
Trauma Claims,'' (Report Number 20-0041-163), nearly half of MST-
related claims denied during a 6-month review were processed
incorrectly. Claims processors failed to apply liberal evidentiary
standards, essential for MST cases due to the difficulty of documenting
such incidents. The report attributed these failures to inadequate
training and oversight, which perpetuates errors and prolongs the
process. Claimants submitting MST-related claims often faced redundant
evidence requests and unnecessarily lengthy appeals due to mistakes in
the initial claims process.
Appeals processing under the AMA has also been affected by
overdevelopment. The 2023 OIG report--``VHA Faces Challenges
Implementing the Appeals Modernization Act'' (Report Number 22-02064-
155) highlighted inefficiencies in providing guidance for higher-level
reviews and supplemental claims. Claimants often encountered delays
caused by inconsistent processes, inadequate tracking systems, and
excessive evidence-gathering requirements. These issues undermine the
AMA's intent to streamline the appeals process and result in
unpredictable outcomes for veterans seeking resolution.
The VBMS has also contributed to overdevelopment. According to the
GAO report titled ``VA Disability Benefits: Training for Claims
Processors Needs to Be Enhanced'' (GAO-24-107510), VBMS faces technical
limitations, including system defects and slow response times. These
issues necessitate manual interventions that perpetuate redundant
evidence requests and inefficiencies. Furthermore, VBMS has not fully
integrated appeals capabilities, complicating claims resolution and
adding to claimants' frustrations.
The NWQ, established to balance workloads across regional offices,
has created additional challenges. Less experienced claims processors
often request additional evidence, which leads to redundant requests
and delays as processors seek clarification or additional records
unnecessarily. The lack of standardized protocols across offices
further exacerbates disparities in decision quality and timeliness.
Fragmented record retrieval processes also remain a significant
hurdle. The NWQ and VBMS exacerbate these delays by frequently
transferring claims between offices, further complicating an already
disjointed system. As we have pointed out, overdevelopment is a
significant problem within the claims and appeals processes.
DAV recommends the following targeted reforms:
Streamline the claims process: Eliminate redundant
evidence requests and enhance automated systems to track claims
progress in the NWQ and VBMS.
Simplify forms: Redesign VA Forms, such as 21-526EZ and
20-0996, to eliminate unnecessary sections and provide clearer
instructions, ensuring veterans can submit accurate claims and appeals
efficiently.
Enhance communication protocols: Establish clear and
consistent standards for duty-to-assist notifications, providing
veterans with specific and actionable guidance on required evidence and
detailing claim status updates.
Expand training programs: Equip claims processors with
specialized training to handle complex cases, including PACT Act
claims, MST-related claims, and AMA appeals. Emphasize proper
application of evidentiary standards and effective communication with
veterans.
Standardize NWQ protocols: Ensure claims are assigned to
processors with relevant expertise to improve decision quality and
consistency across regional offices.
Strengthen compensation and pension examination
protocols: Minimize errors by enforcing comprehensive evaluations and
implementing peer reviews of examination reports for accuracy and
accountability.
Streamline record retrieval: Collaborate with the
Department of Defense to create a centralized, efficient system for
accessing veterans' medical and personnel records. Efforts should also
focus on simplifying processes for obtaining private medical records.
Systemic reforms are essential to eliminate the barriers imposed by
overdevelopment and ensure the VA fulfills its obligation to serve
those who have served. DAV urges Congress to enact these critical
reforms, empowering the VA to provide timely and equitable benefits for
all veterans.
As an accredited veterans service organization, DAV remains
steadfast in its commitment to advocating for the fair and timely
resolution of claims and appeals. Our cost-free advocacy empowers
millions of veterans and their families to navigate the complexities of
the VA system.
Mr. Chairman, this concludes DAV's statement for the record.
Prepared Statement of The American Legion
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Veterans of Foreign Wars of the United States
Chairman Luttrell, Ranking Member McGarvey, and members of the
subcommittee, on behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and its Auxiliary, thank you for the
opportunity to provide testimony on this topic.
Myriad reasons may cause delays in the Department of Veterans
Affairs (VA) disability compensation claims process. However, despite
the reason, they often result in underpayment of claimants and denial
of benefits, at least for a period of time. We will limit our statement
to four common causes of delay: failure to conduct a full review of the
record prior to filing the claim, claim overdevelopment, review of the
physician's medical opinion by a lesser credentialed medical
professional, and anomalies in claims processing automated tools.
Failure to Conduct a Full Review of the Record
A VA Veterans Service Representative must perform a full review of
a record during the development of the claim. In some cases, claims
processors will focus on the first contention in the record and then
base examinations and other actions only on that specific claimed item,
rather than consider the entire scope of the claim. Ordering medical
examinations based on an incomplete understanding of the record could
cause unnecessary or duplicative examinations and medical opinions as
the details of the record emerge. Superfluous medical examinations
contribute to a disjointed process and unnecessary delays.
Overdevelopment
Overdeveloping the claim by ordering unnecessary medical
examinations slows down the claims process and often frustrates the
veteran. Claims for conditions related to toxic exposures seem
especially prone to overdevelopment. Presumption of service connection
satisfies the need for a medical opinion if the claimant's service
record substantiates service in an exposure location and eliminates the
requirement for further medical examination. Any additional
investigation or medical examinations would be redundant and should be
considered overdevelopment. As an example, for a veteran exposed to
burn pits, VA would automatically grant service connection for a claim
for chronic obstructive pulmonary disease (COPD), which is a
presumptive condition attributed to that exposure. VA should not order
a medical examination and incur a delay to determine some other cause
of the COPD, such as the veteran's smoking habits. The VFW recommends
that VA cross reference any previous claims and/or existing medical
records to prevent ordering an unnecessary medical examination that
would contribute to a delay in adjudicating the claim. VA also
acknowledges claims overdevelopment as a problem area and established
its own overdevelopment task force in 2021 to educate claims processors
on strategies to reduce or eliminate this practice.
Review by Lesser Credentialed Medical Professional
Sending the physician's medical opinion to a lesser credentialed
medical professional, such as a nurse practitioner, for confirmation/
certification causes unnecessary delay and should not routinely occur.
Claimants could perceive this practice as developing evidence to deny
the claim rather than offering the veteran reasonable doubt. Time lost
in sending the medical opinion report to this medical provider and
awaiting action contributes to the delay with no increase in accuracy,
quality, or completeness of the claim, and often results in an improper
denial of benefits.
Automated Tools Performance Degradation
Automated tools ease claim preparation, submission, and tracking.
However, VA must monitor their use to detect problems and develop
solutions at the earliest possible opportunity to prevent delays.
Beginning in May 2024, our VFW Service Officers noticed delays over
several months in electronic claims submissions to the Veterans
Benefits Management System. Delays of 40 days were routine persisting
through December 2024. During those months, we met several times with
VA to solve the problem and determine the cause. The situation is
currently resolved with submissions occurring mostly within a day or
two, but we still do not know conclusively what caused the delay or
what to do if it occurs again. A 40-day delay to simply add evidence to
a veteran's record is unacceptable and provides the opportunity for
other situations that could have adverse effects, such as when VA
decides a claim when there is additional evidence waiting for initial
processing that would have resulted in a grant of benefits. When this
happens, the veteran must file an appeal and wait months or years for a
benefit delayed by an incomplete claims file.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has
not received any Federal grants in Fiscal Year 2025, nor has it
received any Federal grants in the two previous Fiscal Years.
The VFW has not received payments or contracts from any foreign
governments in the current year or preceding two calendar years.
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