[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
THE 100% TEMPORARY DISABILITY RATING: AN EXAMINATION OF ITS EFFECTIVE
USE
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
TUESDAY, FEBRUARY 5, 2013
__________
Serial No. 113-2
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida Minority Member
DAVID P. ROE, Tennessee CORRINE BROWN, Florida
BILL FLORES, Texas MARK TAKANO, California
JEFF DENHAM, California JULIA BROWNLEY, California
JON RUNYAN, New Jersey DINA TITUS, Nevada
DAN BENISHEK, Michigan ANN KIRKPATRICK, Arizona
TIM HUELSKAMP, Kansas RAUL RUIZ, California
MARK E. AMODEI, Nevada GLORIA NEGRETE MCLEOD, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
PAUL COOK, California TIMOTHY J. WALZ, Minnesota
JACKIE WALORSKI, Indiana
Helen W. Tolar, Staff Director and Chief Counsel
______
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
JON RUNYAN, New Jersey, Chairman
DOUG LAMBORN, Colorado DINA TITUS, Nevada, Ranking
GUS M. BILIRAKIS, Florida Minority Member
MARK AMODEI, Nevada BETO O'ROURKE, Texas
PAUL COOK, California RAUL RUIZ, California
GLORIA NEGRETE MCLEOD, California
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
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of converting between various electronic formats may introduce
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C O N T E N T S
__________
February 5, 2013
Page
The 100% Temporary Disability Rating: An Examination Of Its
Effective Use.................................................. 1
OPENING STATEMENTS
Hon. Jon Runyan, Chairman, Disability Assistance and Memorial
Affairs........................................................ 1
Prepared Statement of Hon. Runyan............................ 22
Hon. Dina Titus, Ranking Minority Member, Subcommittee on
Disability Assistance and Memorial Affairs..................... 2
Prepared Statement of Hon. Titus............................. 22
WITNESSES
Rick Weidman, Executive Director for Policy and Government
Affairs, Vietnam Veterans of America........................... 4
Prepared Statement of Mr. Weidman............................ 23
Linda Halliday, Assistant Inspector General for Audits and
Evaluations, Office of the Inspector General, U.S. Department
of Veterans Affairs............................................ 6
Prepared Statement of Ms. Halliday........................... 25
Accompanied by:
Larry Reinkemeyer, Director, Kansas City Audit Operations
Division, Office of the Inspector General, U.S.
Department of Veterans Affairs
Brent Arronte, Director, San Diego Benefits Inspection
Division, Office of the Inspector General, U.S.
Department of Veterans Affairs
Diana Rubens, Deputy Under Secretary for Field Operations,
Veterans Benefits Administration, U.S. Department of Veterans
Affairs........................................................ 13
Prepared Statement of Ms. Rubens............................. 30
STATEMENT FOR THE RECORD
Mr. Carl Blake, National Legislative Director, Paralyzed Veterans
of America..................................................... 32
THE 100% TEMPORARY DISABILITY RATING: AN EXAMINATION OF ITS EFFECTIVE
USE
Tuesday, February 5, 2013
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 2:53 p.m., in
Room 334, Cannon House Office Building, Hon. Jon Runyan
[Chairman of the Subcommittee] presiding.
Present: Representatives Runyan, Bilirakis, Amodei, Cook,
Titus, and O'Rourke.
OPENING STATEMENT OF CHAIRMAN RUNYAN
Mr. Runyan. Good afternoon and welcome everyone. This first
oversight hearing of the Subcommittee on Disability Assistance
and Memorial Affairs for the 113th Congress will now come to
order.
I would like to begin this hearing by welcoming all the
Members of the Subcommittee, including our new Ranking Member,
Congresswoman Titus.
Ms. Titus. Thank you.
Mr. Runyan. You're welcome. I am honored to have the
opportunity to continue chairing the DAMA Subcommittee this
Congress and look forward to working with all of you. It is my
hope that we will all come together in a bipartisan way and
share ideas to best serve our Nation's veterans and find
practical solutions to the issues before this Subcommittee.
Our hearing topic today will focus on temporary total
disability ratings. Temporary total disability ratings serve a
very important function in the benefits scheme. This type of
rating is assigned when it is established by medical evidence
that surgery or certain treatment was performed necessitating a
period of recovering during which the veteran cannot work;
however, according to a January 2011 report by the VA Office
and the Inspector General, VBA has not been correctly
processing and monitoring such claims.
As a result, the OIG stated that since January 1993 VBA has
overpaid veterans a net amount of $943 million. The OIG also
stated that without timely action, the VBA could overpay
veterans a projected 1.1 billion over the next five years.
These numbers are troubling to say the least.
As all of us here today are aware, our Nation's fiscal
health is one of this Congress' top priorities. Part of this
process includes trimming government spending and eliminating
government waste.
It is my hope that by brining attention to this topic we
can assure that every dollar appropriated to the VA is being
spent properly on care and benefits for our veterans.
We heard from VA in June of last year during sworn
testimony that the errors were due to a computer glitch. VA
advised that the glitch would be fixed by July 2012.
It is simply unacceptable in a time of tightening belts
that over $1 billion is being wasted by the VA due to a
computer error when the money could be put towards benefits and
health care for our Nation's veterans.
Nonetheless, two new regional office audits by the OIG last
month found that 50 percent of the temporary 100 percent
disability evaluations reviewed were incorrect. The
explanations given in the OIG audits stated that the 50 percent
accuracy rate occurred because the staff did not establish
controls to monitor the processed reductions initially, nor did
they schedule future medical examinations as required.
So something doesn't add up here. If the computer glitch
was fixed in July of 2012, but over 50 percent of the temporary
total rating claims were still being processed incorrectly of
January 2013, that leads me to believe that these are human
errors, not computer errors.
All of us here today are well aware of the growing workload
faced by claims examiners; however, we must remember that even
though each VA employee touches many veterans' lives every day,
an individual veteran has only one file, so it is important to
process every claim correctly the first time.
I want to thank the Vietnam Veterans of America, the OIG,
and the VA for their valuable input as we work together to find
a solution to this problem, and I welcome the witnesses to
continue this ongoing discussion and offer their own specific
recommendations on how to improve not just temporary disability
claims processing, but the entire system of processing
disability claims.
I would now like to call on the Ranking Member for her
opening statement.
[The prepared statement of Chairman Runyan appears in the
Appendix]
OPENING STATEMENT OF HON. DINA TITUS
Ms. Titus. Well, thank you very much, Mr. Chairman, and
thank you for calling today's hearing on this very important
topic.
I also want to thank the witnesses for being here and kind
of apologize for making you wait for us, but we certainly
appreciate you doing so.
As the new Ranking Member of the Disability Assistance and
Memorial Affairs Committee, I look forward to working with you,
Mr. Chairman, and all the Members of this Committee. Some are
not strangers. Mr. Bilirakis and I have been friends for a long
time, and Mr. Amodei, who serves on this Committee, is also
from Nevada, so I think we can have good bipartisan cooperation
as we address these important issues for our veterans.
I also look forward to getting to know the stakeholders
better and to work with them as we try to address how our
veterans receive the benefits that they have so honorably
earned and truly deserve.
As you mentioned today, we are here to examine 100 percent
temporary disability ratings, which is very important to our
wounded warriors.
As you know, 100 percent disability ratings provide
compensation when a disability prevents a veteran from seeking
gainful employment and returning to civilian life that he left
or she left.
You know, we have heard though, that this process that this
system is not working the way that it should be. Previous
audits have pointed out some of the problems, and I think some
of those have been addressed.
In January of 2011, the VA Office of the Inspector General
discovered that 15 percent of the ratings evaluations were
being incorrectly processed. And they projected that these
errors could be corrected, but in the meantime, they could cost
the VA over $1 billion in overpayments.
Now, as the Chair mentioned, but it bears repeating, $1
billion is something to be concerned about. But this doesn't
just go one way in terms of overpayments. At the Reno VA
regional office, which serves my congressional district in
Southern Nevada, the Inspector General found that over half of
the 100 percent disability evaluations were incorrectly
processed. And while a number of these involved overpayments
there were also some under payments, and we certainly don't
want our veterans to be underpaid.
For example, we found one veteran with service-connected
bone cancer and prostate cancer who was underpaid nearly
$10,000 over a period of three years. We must address this.
The IG reported that 93 percent of these errors could be
avoided with three simple fixes: Follow-up exam dates put into
electronic records, calendar notifications that are observed
and not just ignored or overlooked, and if staff secures the
proper medical evidence before changing the evaluation to a
permanent rating.
I am concerned that these problems exist in all the areas,
not just in Nevada, and that is why we need to look at it
nationally.
So I am looking forward to hearing the testimony today, to
look at how some improvements have been made, what we need to
do to be sure that they all go into effect, and I not only want
to hear from you what you have been doing and what the results
are, but I need for you to tell us what we as Members of
Congress can do to help make your job easier and more efficient
and effective.
So thank you very much, Mr. Chairman. I yield to you.
[The prepared statement of Hon. Dina Titus appears in the
Appendix]
Mr. Runyan. Thank you.
With that, at this time I would like to welcome our first
panel to the witness table.
First we will be hearing from Mr. Rick Weidman, Executive
Director for Policy and Government Affairs with Vietnam
Veterans of America. Next we will hear from Ms. Linda Halliday,
Assistant Inspector General for Audits and Evaluations of the
VA, Office of the Inspector General. She is accompanied by Mr.
Larry Reinkemeyer, the Director of the Kansas City Audits
Operations Division and Mr. Brent Arronte, Director of the San
Diego Benefits Inspection Division, both with the VA Office of
the Inspector General.
Your complete and written statements will be entered in the
hearing record.
And Mr. Weidman, you are now recognized for five minutes
for your oral testimony.
STATEMENTS OF RICK WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND
GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA; MS. LINDA
HALLIDAY, ASSISTANT INSPECTOR GENERAL FOR AUDITS AND
EVALUATIONS OFFICE OF THE INSPECTOR GENERAL, U.S. DEPARTMENT OF
VETERANS AFFAIRS; ACCOMPANIED BY LARRY REINKEMEYER, DIRECTOR,
KANSAS CITY AUDIT OPERATIONS DIVISION, OFFICE OF THE INSPECTOR
GENERAL, U.S. DEPARTMENT OF VETERANS AFFAIRS; BRENT ARRONTE,
DIRECTOR, SAN DIEGO BENEFITS INSPECTION DIVISION, OFFICE OF THE
INSPECTOR GENERAL, U.S. DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF RICK WEIDMAN
Mr. Weidman. Thank you very much, Mr. Chairman.
Vietnam Veterans of America appreciates the opportunity to
share some thoughts on this problem under consideration today.
First, I want to thank you publicly having already thanked
you privately for your assistance in making sure that the goals
to our mothers in memory statue project moves ahead by getting
it through the Congress and signed into law, and that is a
great service and I know that most of our moms across America
really appreciate that.
As a general statement regarding VA management, I think all
of us have been concerned for a very long time that--about two
things. One is that there seems to be a lack of accountability
on the part of management at many places, in other words,
people are not held accountable. And secondly, that the
management system measurings may not be the right things.
We believe strongly in the military axiom that a unit does
well that which a commander checks well, and if in fact it is
not being checked well and/or there are incentives to do
something other than what you want them to do then most staff
will take the path of least resistance.
So what you measure and how you measure it and hold
individual adjudicators accountable is absolutely key.
It is important, we believe, to understand the system in
context. Since at least 1998, there has been this thing called
backlog. It has been in the press, people have banged on both
leadership--political leadership as well as civil servant
leadership within the VBA about the backlog, and it has become
almost like a great monster in the background and great for
boating.
We need to move a bit beyond that, because what has
happened is, when a system is under stress, the people in it
are under stress. When people are under stress for a long
period of time their effectiveness and efficiency begins to
drop, and frankly, we think that is part of the problem that is
reflected in the reports before us.
In order words, if you are doggoned if you do, and doggoned
if you don't, and it is repeated over and over and over again
that you don't have adequate resources to meet all of those
demands then the system will show fatigue and make errors. That
doesn't excuse those errors at all, it doesn't excuse the under
payments or the overpayments, but I think it makes it more
understandable.
One of the recommendations made by this Committee in the
past backed up by a number of veteran service organizations,
including VVA, is that Veterans' Benefits Administration do
joint training of adjudicators with our veteran service
officers and the county veteran service officers as well as the
state people. That still hasn't happened.
The importance of that is that if at least everybody is
proceeding on the same base of knowledge, even though
approaching it from a different perspective, we will have many
more fully developed claims that will in fact speed up a lot of
the adjudications.
Number two, our recommendation to help make this better,
this overall situation, is a statement of account that comes
every month that can be automated.
The overwhelming majority of the younger ones and more and
more of older veterans are now in E-benefits and My Healthy
Vet, the respective electronic systems that are a secure
communications with the Veterans Benefits Administration for E-
benefits and My Healthy Vet for the Veterans Health
Administration. It is a way on that they can go on secure thing
mechanism and find out this is what you were paid this month
for X, for Y, for Z. It would help those in the GI Bill
understand what it is for, and it would also help people who
are on temporary 100 percent disability would warn them that if
you haven't had a physical and haven't gone in for a
reevaluation you need to do so. And so it is another way to
make sure there is a backstop in the system.
Number three, the third thing is we certainly will be busy
talking to our friends and supporters on the Appropriations
Committee, and I know this Committee will be sending forth
views and estimates. And I would just stress, because it is--
although a good case can be made from more staff for VBA, I
don't see that happening in this particular fiscal climate. But
what I do beseech you to do is not cut the IT budget. Let the
automation go forth.
A lot of the solution, we all know who have looked at this
and studied it from the Congress' point of view, from the IG's
point of view, is that the more automated this system is, then
you have equal application of the rules no matter where one
lives in this country, no matter which adjudicator is involved,
and so much of the problem will be solved that way.
I see that my time is nearly up. I will just end with
thanking you again for this hearing, Mr. Runyan and Ms. Titus
and look forward to answering any questions and working with
you to improve this vexing situation.
[The prepared statement of Rick Weidman appears in the
Appendix]
Mr. Runyan. Thank you.
And Ms. Halliday, you are not recognized for your
testimony.
STATEMENT OF LINDA HALLIDAY
Ms. Halliday. Chairman Runyan, Ranking Member Titus, and
Members of the Subcommittee, thank you for the opportunity to
discuss the OIG's audit and inspection results regarding the
effectiveness of VBA's processing of temporary 100 percent
disability evaluations.
I am accompanied by Mr. Brent Arronte, the Director in the
OIG San Diego Benefits Inspections Division and Mr. Larry
Reinkemeyer, the Director of the OIG Kansas City Audit
Operations who issued that National Report in 2011.
Delivering timely and accurate benefits and services to
veterans is central to VA's mission.
Processing 100 percent disability evaluations comprises one
important part of VBA's workload; however, our 2011 report, the
audit of 100 percent temporary disability evaluations,
identified veterans receiving long-term payments without
adequate medical evidence to support the continued entitlement
of those benefits.
We projected that since January 1993, regional office staff
overpaid veterans a net amount of about $943 million. Without
timely corrective action, we conservatively projected that VBA
would overpay veterans 1.1 billion dollars over the period of
calendar years 2011 through 2015.
VBA agreed to review temporary 100 percent evaluations to
insure proper controls existed to process these evaluations
correctly; however, VBA's efforts have not been aggressive
enough to effectively address this issue.
VBA did not begin its internal review until September 2011
and extended the review deadline multiple times, extending the
most current deadline to December 31, 2012.
After two years, VBA is still working to complete the
national requirement, and we are concerned about the lack of
urgency in completing this review, which is critical to
minimizing the financial risks of making inaccurate benefit
payments.
Further, our VARO inspections over the past three years
have continued to report systemic problems in VBA's processing
of temporary 100 percent disability ratings. We found
inaccuracies in 66 percent of the cases we reviewed. These
errors resulted in just over $15.5 million in overpayments and
almost $293,000 in underpayments.
Using actual error rates known from our benefits
inspections, today we estimated that approximately $232 million
of overpayments occurred in Fiscal Year 2012. This estimate
compares favorably with the projection that we identified in
our national audit of about $220 million annually.
VBA has testified that system glitches are the reason for
many of the errors related to temporary 100 percent disability
processing.
In 2011 and again in August 2012, VBA modified its
electronic system to insure diary dates automatically populate
and remain in the system without manual entry.
A suspense diary generates an electronic reminder for VBA
staff to schedule a medical reexamination to reevaluate the
case. When there is no reminder, a disability evaluation and
corresponding benefits will continue throughout the veterans
lifetime because nothing calls the case into question again for
review.
We have not tested these system modifications, and
therefore, we have no assurance that they have resulted in
system-wide corrections; however, we do know the system fixes
have not addressed the continuing problem of VA regional office
staff errors in failing to establish and prematurely canceling
suspense diaries that exist in the system.
As long as VBA delays taking effective action to address
this issue, VBA and VA remain at risk of underpaying some
veterans and repeatedly overpaying others without proper
medical support.
Mr. Chairman, thank you for the opportunity to be here. We
would be pleased to answer any questions the Committee and you
would have.
[The prepared statement of Linda Halliday appears in the
Appendix]
Mr. Runyan. Well, thank you both very much for your
testimony. And with that, we will start a round of questions.
My first one is for Mr. Weidman. Can you provide examples
how overpayment has and the subsequent recoup by the VA has
affected a veterans life? Mr. Weidman?
Mr. Weidman. Oh, I'm sorry.
Mr. Runyan. Yes.
Mr. Weidman. What happens on the repayment is, it is more
devastating than ever having received the payment in the first
place, because the people don't have the resources to pay it
back in most cases because they got it, they thought well, I
must have deserved it and been entitled to it, therefore the
money is gone, and they have to either take it out of the
monies which would be much less than 100 percent, usually about
30 or 40 percent of disability, which is much less money, and
it leaves people with a credit history that is destroyed from
which in many cases they never can recover because of having to
pay back an overpayment.
So that is why we suggest this idea of getting everybody on
E-benefits, which all the younger vets are, and sending a
statement of account every month so that they know what they
are getting and why, and there can be additional verbiage that
if they need to come in for an exam to justify continued
receiving at a certain rate, then it puts some onus back on a
veteran to come in and warns him or her that they are heading
for deep waters.
Mr. Runyan. So you would say, if you had that verification
and say they were getting a statement and date certain that
they had to have a medical exam, would you put that onus on
them and do you think they would be able to make that happen,
the veteran themselves?
Mr. Weidman. I think there is actually three entities that
share responsibility here. First of course is VBA who gave the
temporary rating. Second is VHA, which nobody has talked about
yet, which shares--they know that it is their information that
caused the VBA compensation in pension to give the temporary
100 percent. And last, but by no means least, is the veteran
him or herself to know what are they getting and their
responsibility if in fact is of a temporary nature to seek out
an appointment with VHA.
Mr. Runyan. Thank you.
Ms. Halliday, in your opinion why has the VBA failed to
take adequate and timely measures to address the systematic
problems?
Ms. Halliday. I think it is general reliance that they
needed an IT fix and that took some coordination between VBA
and OI&T. We kept telling them it is not just the IT fix. What
we were finding were that VARO staff were not making the proper
input to put these diaries in place. Regardless of whether you
had an IT fix in place, that action had to occur.
So it has been a while that I don't believe VBA has been
aggressive enough in addressing that piece of it.
I know recently Ms. Rubens had laid out some corrective
action that included training, which is consistently
recommended in the benefits inspections reviews to try and
reduce the human error associated with processing some of these
claims.
Mr. Runyan. And going back, you mentioned in your testimony
there about the targeted completion date which was moved
several times from September 30, 2011 to December 31st, 2011 to
June 30th, 2012 and then to December 31st, 2012. Do you know if
the December 31st, 2012 deadline was ever met or has it been
pushed back even further?
Ms. Halliday. We haven't tested for it, but the evidence
would be right now the benefits inspections are still
identifying substantial errors.
Mr. Runyan. And then finally an alarming statistic in your
written testimony says that of the 53 regional offices
inspected during your national audit, none have fully followed
VBA policy in processing temporary disability claims
evaluations.
Can you further elaborate on the extent that these problems
are due to human error as opposed to the computer glitch, and
do you agree with VBA's insistence that system glitches are the
same reason for these errors?
Ms. Halliday. I would like to ask Brent Arronte to respond
since he has spent so much time in our VA regional offices
doing the inspections.
Mr. Arronte. What our inspections have shown is about 46
percent of the errors that we see with suspense dates is what
VBA is saying was the result of a systems glitch. We never
found a systems glitch. To us a glitch means the system was not
working as intended.
We spoke with some about the architecture behind this in
2010 and they told us that the system was never developed to
ensure that these diary dates were populated into the system.
With that, two of the fixes that VBA has indicated that
they have implemented, one in 2011 and one in 2012, we have not
tested that yet, so we haven't obtained the data to see if
those fixes are working systematically.
But what we have seen is about 25 percent of the errors are
related purely to human error where staff is not putting in or
canceling reminder notifications inadvertently, not
understanding how to process reminder notifications, and the
results are benefits being paid when there is no evidence
showing entitlement.
Mr. Runyan. Thank you. And with that, I will recognize the
Ranking Member Ms. Titus.
Ms. Titus. Thank you, Mr. Chairman.
I would like to go back to the points that you were making
about automation, Mr. Weidman and the statement of account,
because that sounds like that is a good idea. It sounds like
that information is always helpful when you are trying to make
decisions about your future, what your health care needs are,
or what opportunities you might be not availing yourself to
that might be out there.
I wondered if you would elaborate on that. Have you talked
to the VA about how this would work, what it would cost, how
much this computer system would work to send out these
statements of account that would have both the payments of what
people are getting and the notice that they might need to go in
for an examination to change their status?
Mr. Weidman. Let me be clear, we don't want them to send
anything out by USPS.
Ms. Titus. Right.
Mr. Weidman. In other words no more paper.
Ms. Titus. Right.
Mr. Weidman. The problem is, is everybody is drowning in
paper now.
But in the E-Benefit system----
Ms. Titus. Uh-huh.
Mr. Weidman. --even though our friends from the IG noted
that the architecture does not call for it, there is no reason
why you can't alter the architecture and the rules that if
someone receives 100 percent disability that is temporary, that
it automatically kicks in to the system so that it doesn't have
to be manually entered.
And that is really what we are driving at of program in
everything you can program, so that you don't depend on an
individual that every singe individual does everything right
all the time. Automate what you can and you avoid a lot of
heartache, and then concentrate on where you need the human
factor brought in, and that is a place where the human factor
has gotten us into trouble, so let us take it out of the human
factor and focus on automation.
Ms. Titus. Well, perhaps I misunderstood. I thought you
said that most of the young veterans were on the E-benefits
program but not everybody is.
Mr. Weidman. Not everybody is, but it is surprising to me
how fast people have taken to E-benefits. We have had an E-
benefits booth at our national convention and our national
meetings and at many of our state conferences around the
country for the last four or five years and people take to it
like ducks to water because it is easier.
And there was a time ten years ago where we had a hard time
getting many VVA members to get on the Internet, and it is a
question of be careful what you ask for. Now they are on the
Internet and I get, you know, 300 emails a day from folks
inside VVA.
But my point is the young ones are already on and the older
veterans are now getting on. It is a way to notify people.
Everybody has access to a computer.
Ms. Titus. Uh-huh.
Mr. Weidman. And because it is through the system that is
already developed adding in the notification and statement of
account that is generated automatically doesn't cost you any
postage, it doesn't cost you anymore staff time, it is just
simply a way of failsafe checking to know what you are entitled
to. And if that is not correct then you can reach out to a
person in the local regional office.
Ms. Titus. Maybe we need a policy to encourage more people
to get onto this system. I know it is perhaps a generational
thing, who uses computers and who is a little more intimidated
by them, so perhaps we could look at that.
I would just ask both of you, do you think these problems
are more problems of process or do you think they are problems
of policy? Do we have the policies in place that will make this
work and they are just not being carried out or complied with
or do we need to change the policy?
Mr. Weidman. I think the policy is adequate, it is a
question of how do we get across the board compliance? And from
our point of view, the across the board compliance really comes
from this is a process that can be automated so why isn't it?
Ms. Titus. Uh-huh.
Ms. Halliday. I would concur that the policy is adequate.
We measure all of our work against that policy. We are looking
for the areas where there isn't compliance, and that is
generally what we find.
So you will have some errors generated with not having
automated edit checks within the system and then you are going
to have people error in a system this large.
Ms. Titus. Do we need better training of our employees?
Ms. Halliday. We absolutely need better training.
Ms. Titus. All right. Thank you, Mr. Chairman.
Mr. Runyan. All right. Mr. Cook. Mr. Cook is now
recognized.
Mr. Cook. Thank you, Mr. Chair.
You know, I am trying to soak all this in here and I've got
to tell you I am very, very disturbed. One as a veteran--
Vietnam veteran and secondly as a former IG. And where you go
in and you discover a problem and where the answer is, well,
the dog ate the computer or it is almost like when I was--after
I retired, I was in the academic environment where you have the
different excuses why certain things couldn't happen.
And so I am kind of curious as to where the onus is on. The
IG goes in there and says, hey, this has screwed up A, B, C, D.
Within six months we want corrective action that says you have
done the following things and then you go back and you check to
make sure that that has been done or hasn't been done.
And so I am wondering is there still this, well, we can't
do it because of technology or because we don't have our people
trained?
And I am trying to accept that, because you know, I've got
to tell you up front, I am a veteran IR-1, very, very
sympathetic, particularly to anybody who has been wounded in
combat, has the whole thing, and it is just unsatisfactory.
You got six months to fix the problem. If you can't do it
for the veterans who put their lives on the line then I am
sorry, we got to get somebody in there who can do it. And that
is my attitude right now.
And so, you know, I am brand new and I come from a
different perspective, sir, you know that I was involved in
this heavily in California and so I get a little bit passionate
about it. So I don't know, the standard excuses about
technology, I just cannot accept at this time.
So I am wondering about follow-up in terms of the
individuals that were involved, when they were going to correct
it, whether they just say we are waiting on technology. If you
can address that I would appreciate it.
Ms. Halliday. Thank you.
We had expected VBA to keep their commitment to work this
national requirement and we just watch slippage upon slippage.
I think that you have to ask VBA as to why it took so long. We
are extremely concerned, given the value of the financial
payments that were going out the door as running benefits that
were not accurate.
The accountability lies with VBA, I think we were very
aggressive in trying to work with them to make sure they
understood the problem and that they went to fix the problem.
We received a lot of push back over just the projection, but
very little focus on fixing the problem.
Mr. Weidman. I understand your attitude about zero
tolerance, Mr. Cook, and from the point of view of the veteran
on the street, absolutely agree with it.
But what I am saying and this whole thing is an example of
a statement of account, only was suggested by our state
president in Alaska in response to a meeting with those going
to school at the university up there and said can we get a
statement of account?
We discussed it with the under secretary last week and they
are going to try and do this. It is actually something that can
be done within the current architecture of the system.
There are some other things that they haven't done that we
have been recommending and this Committee has been recommending
for a long time.
Number one, joint training. It has never gone anywhere. We
are willing to do it and sit down and negotiate what should go
into training of our folks with the VA and frankly they ought
to be sitting down with us, because if the claim is not
prepared correctly they can't adjudicate correctly. Their time
for a properly prepared fully developed claim in adjudication
is ten minutes. You either--it is there or it is not there,
because the way we teach people to organize a claim is in such
a way that you can look and it is there with the supporting
documents and boom.
A lot of the problem comes in when you have a file this
high of disorganized mess and it takes somebody half a day in
order to even give a cursory glance to what is in the file. And
the reason is, it is not properly prepared.
So I think that the understanding on both sides, if you
will, of the veteran service organizations, county veteran
service folks, and the state folks would be much higher if in
fact we had joint trainings in California, in Texas, in where
ever across the country that that would make a great deal of
sense. That is one.
Two, as you probably know from the folks in VBA that you
work with in California, if nothing else we are a tenacious
bunch of SOBs and we will be coming back about getting this
minor tweak, if you will, on the architecture of this system in
order that people can run a statement of account, and number
two, an automatically generated letter and enter it into what
is now a manual thing. Why? I mean why?
Let me offer an analogy, Mr. Chairman, if I may. The
analogy is on the Veterans Health Administration side. They had
scandals all over the country about doing colonoscopies and not
properly cleaning the machines. Well, it turns out that their--
and why do I know this is because I talked to the service
disabled veteran-owned company who makes a machine that is
self-cleaning who they couldn't even get through the door to
show it to VA. And instead of having to depend on a grade three
doing everything correctly to sanitize this machine every
single time in every hospital in the VA system all you do is
flip the switch and boom it is done.
If you can automate it, automate it, and then free up your
FTEE to devote to things that you really need people to do as
opposed to the machines.
Mr. Runyan. Thank you. Mr. Amodei? You have no questions. I
actually have another one and I will open up a second round to
the other members also. This question is just for Mr. Weidman,
it is the only question I have.
As we do get to a point where we have to determine if a
veteran should stay on or should be reduced, what is his
likelihood of actually getting that appointment in a timely
manner?
Mr. Weidman. That depends on a medical center, quite
frankly. The--I said earlier that it is a shared responsibility
with the VHA and--but VHA has never been given or held
accountable to that responsibility, nor have they been held
nearly accountable enough for completing every single question,
if you will, on the C&P examination. And they need to be. And
it is not something that is an imposition on them, it is
something that is part and parcel of their duties and
responsibilities as part of the whole organization and it is
not being done. They have never taken any responsibility for
their part of it.
Mr. Runyan. Thank you. Ms. Titus, do you have anything
further?
Ms. Titus. Just quickly, thank you. I'd like to ask Ms.
Halliday, it disturbs me that the VA and the IG just do not see
eye-to-eye on some of these findings, like the sample size and
audit, when the data was collected, that sort of thing. So can
you just go over for me when the data was collected for the
review that went into the report issued in January of 2013, so
that we can see that that was collected after the VA says some
of these improvements were made that you had recommended
earlier?
Ms. Halliday. Yes. Normally what our benefits inspections
do is they will pull out of the temporary hundred percent that
are active in that last completed quarterly fiscal period. We
take a cyclic approach when we do these.
So we do not expect to really start seeing and being able
to validate the corrective actions till our summer reports,
which we will start pulling that data in March of this year.
Ms. Titus. I am sorry. I know you said you had some
concerns and some preview showed that things still were not
being met, but it is a little unfair to kind of indict the VA
for things that you have not really measured yet; is that
right? Are you comfortable with being able to do that later
this summer, to be able to see if some of these things are
working or not?
Ms. Halliday. We will absolutely see, as we start to pull
the data that falls into post corrective actions on the IT
system modifications. So we do expect to see that.
Ms. Titus. Do you expect it to be better?
Ms. Halliday. I am hopeful it will be better. Although we
have not really tested it, we have had some observations that
appear it works, but we do not have that reasonable assurance
that a full system-wide fix is in place yet.
Ms. Titus. Okay. Thank you, Mr. Chairman.
Mr. Runyan. Mr. Cook, Mr. Amodei, anything else? No. With
that being said, ladies and gentlemen, on behalf of the
Subcommittee, I thank you for your testimony and look forward
to continuing to work with you on these important matters, and
you are now excused. And I will call the next panel up.
At this time, I will welcome Ms. Diana Rubens, Deputy Under
Secretary of Field Operations in the Veterans Benefits
Administration at the U.S. Department of Veterans Affairs. I
appreciate your attendance today. Your complete and written
statement will be entered in the hearing record. Ms. Rubens,
you are now recognized for five minutes for your testimony.
STATEMENT OF DIANA RUBENS
Ms. Rubens. Thank you. Good afternoon, Chairman Runyan,
Ranking Member Titus, and Members of the Subcommittee. Thank
you for the opportunity to discuss the Veterans Benefits
Administration's process of the temporary 100 percent
disability rating.
As we have all mentioned, the VA regulations authorize 100
percent disability rating under specific criteria, tied to
individual disabilities or when any service-connected
impairment of mind or body makes it impossible for a veteran to
pursue substantially gainful employment.
These can be granted either on a temporary or permanent
basis. VBA grants a permanent rating if medical evidence shows
the veteran's total disability is not likely to improve. A
temporary 100 percent disability ratings are awarded when
service-connected disabilities require complex surgery,
convalescence, or specific in-patient or intense treatment,
such as radiation or chemotherapy.
At the end of that period of convalescence or following
association of treatment, VBA is responsible for reviewing the
veteran's medical condition to determine whether to continue
the temporary 100 percent rating.
If the medical exam shows material improvement in the
veteran's condition, and VBA determines a reduced rating is
necessary, we then initiate an action to reduce benefits.
When VBA proposes a reduction in benefits, the beneficiary
is notified and they have an opportunity to submit additional
evidence and/or request a pre-reduction hearing. It is also
possible that the 100 percent evaluation is determined to be
permanent.
In January of 2011, the VA OIG released the report of its
audit, of our temporary 100 percent disability ratings. The
audit examined two areas, whether VBA regional offices were
correctly assigning 100 percent disability ratings as either
permanent or temporary, and whether RO's were effectively
monitoring and re-evaluating those temporary ratings.
The audit found the temporary 100 percent disability
ratings were not being correctly monitored for re-evaluation.
They identified three primary causes, and made seven
recommendations, including a recommendation that VBA review all
temporary 100 percent disability ratings, to ensure each
evaluation had a future examination date entered into the
electronic record, and to continue reviewing all temporary 100
percent disability ratings going forward. We agreed to
implement all of those recommendations.
Our challenges we have talked about was the system. In
September of 2010, during the course of the audit, we
identified, VBA identified a system software problem causing
many properly established future exam dates to drop out of the
system, contributing significantly to the problems being
identified by the IG.
After extensive analysis, the VA determined that the
complexity of the system requirements for future examination
processing required a complete redesign of that system
functionality. Unfortunately, the first fix that we implemented
in June of 2011 simply revealed additional problems, which were
not fully resolved until July of `12. That redesign
successfully corrected the previously identified system
defects, and we believe has corrected the problem going
forward.
During the extensive system correction, VBA took two
courses of action. The first extensive and ongoing training of
our workforce and claims reviews. These reviews were conducted
three separate times to ensure future examination dates were
properly recorded for temporary 100 percent ratings and to
schedule medical exams for those veterans who were overdue for
re-evaluation.
In the course of the reviews, VBA continued to identify
cases that were not properly controlled or tracked for
completion of all required actions. Either because proper
corrective action had not yet been taken, or had been taken
prior to the July 2012 system fix.
To address the concern, a back-up process has been put into
place to identify cases without a future examination date
established, and require a review of these cases to either
establish a future date or ensure the rating decision correctly
documented that hundred percent rating as permanent.
Because of the input of the future exam dates, remains a
manual input process within our current legacy system, we
continue this back-up process to ensure that the hundred
percent ratings are appropriately identified as either
temporary, with a future exam scheduled, or as permanent. That
review is being done every two weeks.
Equally important to VBA's long term management of our
temporary 100 percent evaluation is our transformation process.
The culmination of people process and technology enhancements
designed to eliminate the claims backlog and achieve our goal
of processing all claims within 125 days at 98 percent quality.
Our new paperless processing system, the Veterans Benefits
Management System, is employing rules based functionalities
that will allow VBA to more effectively monitor and timely
adjust 100 percent ratings.
Using all that we have learned and implementing the fixes
in our legacy systems, once VBMS is in place nationwide, these
rule sets will ensure we automatically comply with the business
rules and procedures associated with temporary 100 percent
ratings.
VBA is committed to providing timely and accurate payments
to veterans while ensuring proper stewardship of taxpayer
dollars. We have already taken significant corrective actions,
including case review, legacy system software changes,
mandatory training, increased oversight, and technology
enhancements into our new VBMS system, to ensure that our
temporary 100 percent ratings are monitored and adjusted
appropriately.
At the same time, we acknowledge our regional offices have
not yet completed action on all the individual cases requiring
review. We continue to carefully monitor with these cases to
completion, partnering with OI&G to ensure we are providing
veterans with timely and accurate benefit payments.
This concludes my statement. I would be pleased to answer
any questions you or the Members of the Subcommittee may have.
[The prepared statement of Diana Rubens appears in the
Appendix]
Mr. Runyan. Thank you, Ms. Rubens. In your written
testimony, you stated that the redesign completed on July 2 of
2012 fixed the computer issue. Can you explain why the most
recent IG or OIG reports for the Anchorage and Detroit regional
office, which were issued in January of `13, a full two years
after the OIG's initial review, have indicated more than half
of the temporary total disability claims were processed in
error?
Ms. Rubens. Yes, Chairman Runyan, thank you. As I reviewed
those most recent reports on Detroit and Anchorage, and find
that the data collection that they used to base their
assessment on was from January to March of 2012, prior to the
final full system fix.
We acknowledge that during that time we were continuing to
review from an annual standpoint the listing of cases, but also
realized that the full system fix did not go into place until
July of 2012.
Mr. Runyan. Do you dispute the number that human error
accounts for 25 percent of that?
Ms. Rubens. I would tell you that we readily acknowledge
the human element, if you will, of the rating activity. Wherein
as a rating specialist has to indicate whether or not it is
permanent or temporary evaluation, and that the diary needs to
be put into place. We believe that we have done a tremendous
amount of training, and will continue to do that to ensure that
the human element is also addressed.
Mr. Runyan. In layman's terms, is there a 30-second
response to what was the nature of the computer glitch?
Ms. Rubens. I will do my darndest to put it in something
not too technical, which shouldn't be too hard, because I am
not too technical.
As I understand it, as we would put the diary into the
system, indicating that the veteran would require a future
review exam, if subsequent award action was taken for that
veteran, having nothing to do with the review, it would drop
that diary out of the system; thereby, if you will, erasing the
reminder that would pop up at the appropriate time to do the
review exam.
Mr. Runyan. Okay. According to the OIG's testimony, the
National Review that VBA said it would undertake in 2011 has
been repeatedly delayed, with the most recent postponed delay
dated December 31st, 2012 was the National Review completed by
December 31st, 2012, or was the deadline pushed back even
further? I had asked that question in a previous panel, and I
would like to see if you have pushed it back even further.
Ms. Rubens. So as we initially had the conversation about
the need to conduct the review, identified the problem within
the system, there were, I am going to call it, several buckets
that we looked at of work that we wanted to look at.
We started first with the first--the top three, most
prevalent conditions that were causing the system review need.
There were about 81,000 of those initially. As we reviewed
those very quickly, the next thing that we began to do was
establish through lists the reviews required for subsequent
claims.
Those began to be issued to regional offices in January of
`12, and were issued through all of FY `12. So when you say
that we have delayed, I would say that we had different
buckets. We had what we thought was going to be a system fix in
June of 2011, identified, in fact, that that was not the fix
that we needed, and if you will, went back and continued to
pull those other claims to ensure that in the translation, if
you will, we hadn't lost track.
Even today, as we have veterans who are granted a temporary
100 percent disability evaluation, while we believe that we
have got the system fixed in place that requires our rating
specialist to indicate this evaluation is permanent or this
evaluation requires a review, we recognize the human element of
somebody having to put that in, that verification that it is
permanent.
And so that is why we are continuing to run every two weeks
a trap, if you will, on new 100 percent evaluations to ensure
it either indicates it is permanent, or it is temporary, and it
has a diary established, to ensure that the human element, as
it comes into play, is backstopped if you will by technology.
Mr. Runyan. That tool is in the current version of VBMS?
Ms. Rubens. Both in our legacy system, and as we were
building VBMS, the functionality is coming into play there as
well. So we are trying to do it on both sides.
Mr. Runyan. Thank you. I would like to recognize the
Ranking Member Ms. Titus.
Ms. Titus. Thank you, Mr. Chairman. Earlier, Ms. Halliday
said she hopes the next review will show that these things you
have put in place show improvement. Do you hope so, too, or can
you give us more reassurance than that?
Ms. Rubens. I am going to give you more reassurance. We
have done over half a dozen training sessions around all of the
issues of permanent and total ratings, reviews for both our
veteran service representatives as well as our rating
specialists. We believe that the fix is in place, but also to
ensure that, in fact, both the human component, as well as the
technology component are working, we are running those filters,
those traps, if you will, every two weeks and generating or
capturing any of those that are not either permanent or have a
future diary in place, and ensuring that the regional offices
are reviewing those lists promptly to indicate one or the
other.
Ms. Titus. Do you have any sense, or any record, or any
calculation of how much was overpaid during the time it took
you to fix that glitch?
Ms. Rubens. So for the first group of claims that we
reviewed, that first 81,000, as we looked at the number of
reviews, in fact, 70 percent of those are now permanently rated
at a hundred percent. As we continued to look, an additional 15
percent of those are still temporarily rated at a hundred
percent, and have that future diary established. Ongoing care
or treatment necessitates that push out, if you will, of the
review exam.
And unfortunately, 13 percent are now deceased and I would
say I am not sure that we could evaluate or assess that that
rating should have been reduced, and that about 2 percent of
them where we have reduced the rating.
So I would tell you that as we look at our estimate, it
would have resulted in something closer and still not
acceptable, $215 million in overpayments. Part of the system
fix that we think that we have got in place now to go along
with the training in the future as we move into the electronic
environment, that we build into our veterans' benefits
management system, incorporating the rules based components
into our new environment to ensure we continue to monitor and
evaluate our temporary 100 percent evaluation utilization.
Ms. Titus. Have you considered Mr. Weidman's recommendation
about that statement of account? Do you think that would work
or be helpful for you all could do that?
Ms. Rubens. I will tell you that we have seen tremendous
growth and utilization of our E-benefits account. From about 18
months ago, it was somewhere in the 200, 250,000 accounts to
over 2 million today. Every quarter, we look to establish new
functionality to make the system better and more user friendly
for our veterans. Mr. Weidman's idea is terrific, one that I
think goes along with the efforts that we are engaged in now to
begin to use our E-benefits account as our notification for
anything having to do with a claim, and this is a perfect
combination to incorporate the temporary 100 percent
evaluation.
Ms. Titus. And just one last thing, as I understand it, if
you have been on temporary disability for 20 years, it
automatically becomes permanent; is that right?
Ms. Rubens. Yes, ma'am.
Ms. Titus. Is that a figure that needs to be addressed or
does that work well or does that accommodate our veterans?
Ms. Rubens. I do not have any information, but I can take a
look at the number that actually get to that 20-year marking
and get back to you.
Ms. Titus. Okay. Thank you, Mr. Chairman.
Mr. Runyan. Thank you. Mr. Cook?
Mr. Cook. I am almost afraid to speak or ask questions on
this. I appreciate your candor on this. I probably have, I do
not know, personal experiences with this because I did deal
with the VA, particularly when the different rules had changed
for Agent Orange, because full disclosure, I was diagnosed and
treated for leukemia. And, you know, I talked to my oncologist
and what have you, and he said, well, it is probably related to
Benzine, and he was giving me the medical background, but he
also talked about Agent Orange. And early on, the VA did not
make that correlation. They did not want to give a benefit.
I wanted to see how this would work, because I had a lot
of--I belong to a lot of veterans organizations, including the
one that was represented at the table, and the Disabled
American Veterans and everything else. I submitted a claim to
see what would happen. And it was kind of frightening, in that
I got a phone call to come down there, and I did all the
physicals and then about six months later, they said, well, can
you come back for a follow-up. So I came in there. And they
said, you have to have a hearing examination. I said, what do I
want a hearing examination for. And they said, well, you know,
your disability, you know, I said, it has got nothing to do
with hearing, I think I can hear fine except when my wife is
talking, and then I have problems.
But they had my name mixed up, and it is also based on
social security number, so I was kind of shocked about it. I
said, well, what about the claim that I put in there, to see
if--they said it is being processed.
About three months later, it came back, and it said it was
disapproved because there was no evidence that I was in
country, meaning Vietnam, even though I had submitted a DD-214,
had a physical examination, and had evidence that I had been
awarded two Purple Hearts, which I did not get in a barroom
brawl at Camp LeJeune, it was actually in Vietnam.
So I was just very disturbed in terms of the process or
following through. It was kind of like an ongoing battle, and I
got very frustrated. I have got to be honest with you. But
talking to other veterans, particularly Vietnam veterans, there
is a perception out there, which is very, very dangerous that
the VA does not care about them. And this is an awful thing to
say, and I think there are veterans, and I mention the Vietnam
veterans that feel, well, you know, we are going to die anyway,
we are at that age bracket now, where we are dying in X amount
right now, and they do not want to address our concerns.
So it is not just a glitch in the system, at least from my
perception. There is that feeling that if you are one of these
categories that are in the categories of Vietnam veterans that
the perception is, as I said, that you are not to have the same
attention or--and I would hope that this is not true, and I do
not think it is, but because of some of these areas where the
computer is down, these things with veterans' groups and--they
get really excited about it, you know, all these different
veterans' groups, they are almost paranoid on some of these
things.
So I think it is not just an issue of the payment and
overpayment, it is whether this organization that was formed to
help the veterans is actually carrying through on that. And I
would hope that, you know, in addition to that, that could be
looked at in terms of this perception and how it gets out to
these veterans. If you want to address that, I would appreciate
it.
Ms. Rubens. Certainly, Mr. Cook. And I would say first,
thank you for your service. I apologize for the personal
experience that you had, and I would tell you that there have
been a number of things that VA and VBA in particular have been
working to do to change that perception. And I would say on two
fronts, one from the more current conflicts, the level of
effort that we have put in to ensuring that the transition is
one where we are providing as much information as possible
about the benefits available to them, and it is part of a
comprehensive briefing, if you will, that looks not just at
what VBA will do, but what VA can do as well as Department of
Labor, Department of Education.
From the Vietnam veteran experience, I recognize that that
is something that from a timing standpoint, I cannot speak to
personally. I can tell you that from the standpoint of VA
today, we have worked very hard to ensure--we are changing
those experiences. Perhaps at the conclusion, I could maybe get
a little more insight from you about timing.
But, in particular, Secretary Shinseki in 2009 addressed
the evidence before him to incorporate three additional
presumptives, and as you mentioned, leukemia. I particularly
hope we can speak privately about that.
But adding to the list of diseases acknowledged as due to
the exposure of Agent Orange, Parkinson's, a couple of
leukemias, as well as the Ischemic Heart Disease, VBA starting
in May of 2010, quite frankly, sir, began a concerted effort to
ensure that those Vietnam veterans who had now waited for, in
many cases, 40 and 50 years for decisions on those claims had
those addressed.
We believe that we have worked under the auspices of the
Nehmer decision from 1985 to ensure that the review of those
claims has been done in an expeditious quality manner, and
continued to work to reach out and ensure that any Vietnam era
veteran who had perhaps exposure to Agent Orange and has not
had that addressed, has an opportunity to work with us and
ensure that we do that.
Mr. Runyan. Thank you, Mr. Cook. I have a very technical
question. I want to make sure I get it right.
Ms. Rubens. Okay.
Mr. Runyan. I want to talk about training a little bit,
outlining your testimony. But my understanding, the temporary
ratings are not reduced, they simply expire by virtue of the
fact that they are temporary, correct?
Ms. Rubens. If you were granted a temporary 100 percent
evaluation in the system, and we have a diary established, it
will come up and we will review any medical evidence that we
have. And if it is not sufficient to make a determination as to
whether or not permanency should be granted or the temporary
evaluation extended, we will request an exam.
The veteran also has the opportunity to present evidence.
So it will not just automatically turn off if you will, to
ensure that perhaps that veteran who is undergoing treatment
for cancer, that has not responded well, if he or she is still
undergoing treatment, that that is not turned off while they
are still in treatment. Or if a rehabilitation or a
convalescence from a surgery has not gone as planned, does not
get turned off.
So it is a due process approach, wherein we will notify the
veteran of the need for an exam, review the evidence, and make
that determination at that time.
Mr. Runyan. Because it--even going through some of this, it
seems, even with some of the regulations when you look at 38
CRF 4.30, VA's regulation governing temporary disability rating
explicitly states, and I quote, ``Termination of these total
ratings will not be subject to 3.105(e) of this chapter, which
permits a rating--where it pertains to rating reductions, but
that such total rating will be filed by appropriate schedular
evaluation.'' So it is, I think just in the regulations right
there, it is very confusing. And when you--now you go to my
first comment of this question, how do you train somebody to
actually analyze that, and actually adjudicate that?
Ms. Rubens. So I think there is a two-fold answer to that.
And the first, of course, is that we are conducting the
training to address that. And frankly, the second component is,
I have begun that conversation with our compensation service
responsible for policy to ensure. If there is room for us to
clarify the guidance out there, that we in fact work to do
that, not only for the rating specialist who today are
administering that, but to ensure that as we are building tools
into our technology, that it is a more straightforward process
to ensure that we, I will say, support and supplement the human
factor engaged in that.
Mr. Runyan. Thank you. And just one last comment. I know
there has been, whether it is the VA disputing the IG numbers
or what, I think we all admit there is a problem, and the
faster we get to the bottom of it, the more veterans we are
going to be able to help. I think that is what we need to focus
on. I think we waste a lot of energy a lot of times arguing
over the dollar amount. We realize there is a problem, but
there is a lot of time and personnel we can put towards fixing
the problem.
Ms. Rubens. Yes, sir. We are working with the IG to ensure
that if they have got some other ideas on what we ought to be
looking at, that we work together to do that.
Mr. Runyan. Ms. Titus, any further questions? Mr. Cook?
Nothing.
Well, with that, on behalf of the Subcommittee, I would
like to thank you for your testimony. We look forward to
working closely with you in addressing these important issues
again, and it is having an enormous impact on our Americans,
veterans, you are now excused. And I thank everyone for being
here today. I would again like to emphasize, I look forward to
working with all of you throughout this Congress to provide
American veterans across this Nation with timely and accurate
benefits and the decisions they deserve.
I would like to thank all of our witnesses for being here
today to participate in the discussion on what is a stubborn
problem, but one that can be easily resolved so that we return
our attention to the more complex claims. I ask for unanimous
consent that all members have five legislative days to revise
and extend their remarks, and include any extraneous material.
Hearing no objection, so ordered. I thank the members for
their attendance today, and this hearing is now adjourned.
[Whereupon, at 4:00 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Jon Runyan, Chairman
Good afternoon and welcome everyone. The first oversight hearing of
the Subcommittee on Disability Assistance and Memorial Affairs for the
113th Congress will now come to order.
I'd like to begin this hearing by welcoming all the members of our
Subcommittee, including our new Ranking Member, Congresswoman Titus. I
am honored to have the opportunity to continue Chairing the DAMA
Subcommittee this Congress and look forward to working with all of you.
It is my hope that we will all come together in a bi-partisan way and
share ideas to best serve our Nation's veterans and find practical
solutions to the issues before this Subcommittee.
Our hearing topic today will focus on temporary total disability
ratings. Temporary total disability ratings serve a very important
function in the benefits scheme. This type of rating is assigned when
it is established by medical evidence that surgery or certain treatment
was performed, necessitating a period of recovery during which the
veteran cannot work.
However, according to a January 2011 report by the VA Office of the
Inspector General, VBA has not been correctly processing and monitoring
such claims. As a result, the OIG stated that since January 1993, VBA
has overpaid veterans a net amount of $943 million. The OIG also stated
that without timely action, VBA would overpay veterans a projected $1.1
billion over the next five years.
These numbers are troubling, to say the least. As all of us here
today are aware, our Nation's fiscal health is one of this Congress's
top priorities. Part of this process includes trimming government
spending and eliminating government waste. It is my hope that by
bringing attention to this topic, we can ensure that every dollar
appropriated to VA is being spent properly on care and benefits for our
veterans.
We heard from VA in June of last year during sworn testimony, that
these errors were due to a computer glitch. VA advised that the glitch
would be fixed by July 2012.
Nonetheless, two new Regional Office audits issued by the OIG last
month found that 50 percent of the temporary 100 percent disability
evaluations reviewed were incorrect. The explanations given in the OIG
audits stated that the 50 percent accuracy rate occurred because staff
did not establish controls to monitor the proposed reductions
initially, nor did they schedule future medical examinations as
required.
So--something doesn't add up here. If the computer glitch was fixed
in July 2012 but over 50 percent of temporary total rating claims are
still being processed incorrectly as of January 2013, then that leads
me to believe that these are human errors, not computer errors.
All of us here today are well-aware of the growing workload faced
by claims examiners. However, we must remember that even though each VA
employee touches many veterans' files every day, an individual veteran
has only one file, so it's important to process every claim correctly
the first time.
I want to thank the Vietnam Veterans of America, the OIG, and VA
for their valuable input as we work together to find a solution to this
problem.
I welcome today's witnesses to continue this ongoing discussion and
offer their own specific recommendations on how to improve not just
temporary total disability claims processing, but the entire system of
processing veterans' disability claims.
I would now call on the Ranking Member for her opening statement.
Prepared Statement of Hon. Dina Titus
Mr. Chairman, I would like to thank you for holding today's hearing
and to our witnesses for appearing before the Subcommittee today.
As the new Ranking Member of the Subcommittee on Disability
Assistance and Memorial Affairs, I look forward to working with you,
Mr. Chairman, the other Members of this Subcommittee and all of our
stakeholders to tackle the claims backlog, ensuring that our nation's
veterans receive the benefits they have honorably earned and rightfully
deserve.
Today we are here to examine the issue of 100 percent temporary
disability ratings. We know that for our most wounded warriors, a 100
percent disability rating provides compensation when a disability
prevents them from seeking gainful employment.
But in January 2011, the VA Office of the Inspector General
discovered that 15 percent of these rating evaluations were being
incorrectly processed. The IG projects that these errors will cost the
VA $1.1 billion in overpayments during the next five years.
At the Reno VA Regional Office, which serves my Congressional
District in Southern Nevada, the Inspector General found that over half
of the temporary 100 percent disability evaluations were incorrectly
processed. While a number of these cases involve overpayments, some
veterans are being underpaid as well, particularly as it relates to
special monthly compensation. For example, the audit of the Reno Office
found one veteran with service-connected bone cancer and prostate
cancer who was underpaid nearly $10,000 over a period of three years.
The IG reported that 93 percent of the errors could have easily
been avoided through three seemingly simple fixes:
1. If follow-up exam dates were entered in the electronic record;
2. If calendar notifications were observed and not just ignored or
overlooked; and
3. If staff secured the proper medical evidence before switching a
veteran's evaluation to a permanent rating.
I was concerned when I learned that the IG has found the similar
errors in all 42 regional offices inspected since this initial audit
with an average of 62 percent of these evaluations still being
processed inaccurately.
It is my understanding that following this audit, in July of 2011,
the VA instituted a technical fix to their computer systems that
eliminates the potential for many of the instances of human error that
the IG found in their January 2011 Report. I look forward to Deputy
Under Secretary Rubens' testimony on the results that these software
changes have had on the claims management systems.
I hope today's hearing will shed light on why there still seems to
be problems in this area, two years after the IG report, and after the
VA took steps to address these concerns. Is this a problem with
systems, with training, with accountability, or a combination of these
factors?
I hope we will discuss what system fixes have been made, and what
management and employee accountability procedures have been implemented
since the IG report to prevent these types of inaccuracies. I hope at
the end of this hearing that we will reach a consensus on how to
address and fix these problems today, and, looking forward, how we
ensure they do not happen in the future.
Thank you, Mr. Chairman. I yield back.
Prepared Statement of Rick Weidman
Good afternoon, Mr. Chairman, Ranking Member Titus, and
distinguished Members of the Subcommittee. Thank you for giving Vietnam
Veterans of America (VVA) the opportunity to offer our comments on the
issues regarding the 100% temporary disability ratings with this
distinguished committee today.
We have reviewed the three reports from the Inspector General of
the U.S. Department of Veterans Affairs (VA) that were issued earlier
this month, VA OIG 12-02089-60, January 3. 2-13, entitled ``Inspection
of VA Regional Office Anchorage, Alaska''; VA OIG 12-03355-88, January
11, 2013, entitled ``Inspection of VA Regional Office Detroit,
Michigan''; and VA OIG 09-03359-71, January 24, entitled ``Veterans
Benefits Administration-Audit of 100 Percent Disability Evaluations.''
We have analyzed all three reports looking for common threads, and
much of the problem is simply failure to consistently use the
procedures and tools that are in place. It is clear that the same issue
we have all been pressing on for some years, lack of management
oversight, is the problem that causes the failure to follow correct
procedures. Some of this is because there is not proper accountability
mechanisms for managers, and part of it is due to insufficient
resources overall in Compensation & Pension (C&P).
As to a general statement regarding management, VVA firmly believes
the military axiom applies here: that a unit does well that which a
commander checks well. The huge delays (up to 900 days in one instance)
simply are something that should not ever occur.
The Veterans Benefits Administration (VBA) management can do a
better job of teaching staff how to better and more accurately
adjudicate claims, as well as how to work better with the veterans'
service organizations, as well as state and county representatives so
that there are more fully developed claims coming into the system. VVA
and others have been suggesting/urging joint training for some time,
but it has yet to happen at any level, to our knowledge. The more
complete and better organized these claims are when they are received
by the Regional Office staff, the more quickly and accurately they can
be adjudicated. If both the VBA staff and the VSOs, et.al. are at least
working off of the same knowledge base, albeit a different perspective,
then it is much easier to reach an accurate decision quickly, one that
is to the satisfaction of all in more than nine out of ten cases.
Common/joint training was a recommendation from this committee almost
ten years ago, but nothing has ever come of it.
A word about overall resources at VBA would be in order here. While
the budget and the number of personnel at the Veterans Health
Administration (VHA) increased dramatically to handle a mounting
workload, especially in the period from 2006 to 2010, the VBA gains in
resources and staff during that same period did not keep pace with the
increase in the overall increase in both the number of claims filed
with C&P, and at the same time a sharp increase in the complexity of
cases filed.
While VBA ``Fast Letters'' and other directives are by and large
well intended, and usually reasonably well thought out, the ``word''
often does not reach the individual staff member in a Regional Office
in such a way as to modify either their understanding of an issue nor
their behavior in applying that understand to individual claims. The
technical term, of course, is ``bureaucratic slippage.'' While that is
common in any governmental organization, it is particularly a problem
when a large system is ``under stress.''
There has been an acknowledged issue of a serious backlog of C&P
claims since at least 1998. Two Presidential Administrations in a row
have taken office vowing to eliminate this ``backlog'' thing that has
become a dark and foreboding backdrop to all that occurs at VBA. All
agree that the real task is to modernize this paper system, and drag it
into the 21st century. The ``backlog'' has now continued under the last
five Secretaries and two Acting Secretaries of Veterans Affairs. VBA
has been under stress for all of this time, which is well more than a
decade.
All of this has taken a real toll on this system and the people in
it. Some of the failures to pick up on major errors or ensure that
basic tools are consistently utilized to avoid either overpayments or
underpayments is simply organizational fatigue. This does not excuse
these failures, but it does help us to understand it better.
The real solutions to the problem(s) facing C&P are to be found in
the need to automate much of the system. VBA is finally on the right
track in seeking to use open architecture computer systems in such a
way that much of the direct contact with human beings can be
eliminated, thereby avoiding the possibility of a rule not applied or
applied incorrectly to one or more elements in a claim by a staff
member who ``did not get the word'' at one or more Regional Office.
Using automation the rules would be consistently applied no matter
where one lives in the nation. The only way to do that is to set as
many claims as possible up in such a way that the applicant veteran can
enter his/her own data and apply via the secure ``e-benefits'' web
portal. It is our understanding that later this year a veteran will be
able to add or drop a dependent on line, without the necessity to have
a staff person do it for them. (This does not address the stacks of
more than 180,000 claims to be ``adjusted'' that are not counted in the
overall number that is currently acknowledged as the backlog. Many of
these adjustments are vitally important, as not addressing them in a
timely way means that Champ VA is not applied to newborn dependents
until quite some time later. Needless to say, the healthcare needs of
both the mother and child do wait on VBA to get around to the
``adjustments.'')
We understand the concern the committee has with the possibility of
overpayments of temporary payments at the 100% level. Let us suggest
that this can be addressed by automation in two ways that do not
require additional computer capacity beyond what is already planned:
First, we urge that the VBA send a monthly ``Statement of Account''
to the through the ``E-Benefits'' portal to all veterans receiving
funds from VA for any purpose, informing them of each element of
amounts paid, and the purposes for which VA made each of these
payments.
Part of the message in that same letter can/should be to
automatically inform veterans receiving a temporary disability that it
is their responsibility to seek out a medical exam after a certain
date, and/or if their condition significantly approves.
Similarly, our leadership in Alaska has informed us that many
attending higher education on the 21s5t century GI Bill get a different
amount each month, with no explanation as to what each varying amount
is for. The ``Statement of Account'' via secure electronic
communication would remedy this problem.
Let me note that VVA's concern with overpayments is that like
others we are concerned that the taxpayer's money is used correctly.
Additionally though, overpayments do as much or greater damage than
underpayments because when there comes the inevitable move to recoup
these funds, veterans' credit often takes a whack from which they may
never recover, so it is important that both under and over payments be
avoided.
Finally, VVA urges the Committee in the strongest possible terms to
do all that is necessary to ensure that the computerization funds for
VBA do not get decimated. We are aware that they are unlikely to get
any more staff at this juncture (although a strong case can be made for
this need), so it is important that the move to computerize as much as
possible not be derailed at this critical juncture.
Mr. Chairman and distinguished Members on this panel, VVA thanks
you for the opportunity to present our views here today. I will be
pleased to answer any questions you or your colleagues may have.
VIETNAM VETERANS OF AMERICA
Funding Statement
February 5, 2013
The national organization Vietnam Veterans of America (VVA) is a
non-profit veteran's membership organization registered as a 501(c)
(19) with the Internal Revenue Service. VVA is also appropriately
registered with the Secretary of the Senate and the Clerk of the House
of Representatives in compliance with the Lobbying Disclosure Act of
1995.
VVA is not currently in receipt of any federal grant or contract,
other than the routine allocation of office space and associated
resources in VA Regional Offices for outreach and direct services
through its Veterans Benefits Program (Service Representatives). This
is also true of the previous two fiscal years.
For Further Information, Contact: Executive Director for Policy &
Government Affairs, Vietnam Veterans of America, (301) 585-4000,
extension 127
Prepared Statement of Linda Halliday
INTRODUCTION
Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to discuss issues related to the effectiveness of the
processing of temporary 100 percent disability ratings by Veterans
Affairs Regional Offices (VARO) that were identified in an Office of
Inspector General (OIG) audit report in January 2011 and that continue
to be reported in OIG Benefits Inspections reports to date. I am
accompanied by Mr. Brent Arronte, Director, OIG San Diego Benefits
Inspection Division, and Mr. Larry Reinkemeyer, Director, OIG Kansas
City Audit Operations Division.
BACKGROUND
Delivering timely and accurate benefits and services to veterans is
central to VA's mission. The Veterans Benefits Administration (VBA) is
responsible for administering a range of veterans benefits programs,
including compensation, pension, education, home loan guaranty,
vocational rehabilitation and employment, and life insurance. These
programs will pay out over $76 billion in claims to veterans and their
beneficiaries in fiscal year (FY) 2013, and comprise approximately half
of VA's total budget.
Processing 100 percent disability evaluations comprises one part of
VBA's claims workload. VBA policy allows veterans to receive 100
percent disability evaluations for impairments of mind or body that
would make it impossible for the average person to pursue a
substantially gainful occupation. These impairments may be permanent or
temporary. VBA policy requires a temporary 100 percent disability
evaluation for a service-connected disability following a veteran's
surgery or when specific treatment is needed. At the end of a mandated
period of convalescence or treatment, VARO staff are required to
request a follow-up medical examination if available evidence is not
adequate to help determine whether to continue the veteran's 100
percent disability evaluation.
The OIG's work over the past 3 years has disclosed systemic
problems in VBA's processing of these disability evaluation decisions.
Specifically, our 2011 report, Audit of 100 Percent Disability
Evaluations, identified veterans receiving long-term payments caused by
significant VARO processing errors, leading to veterans receiving long-
term payments to which they were not entitled. We have repeatedly
identified the same problems in our VARO Inspections Program, where we
inspect the 57 VAROs and follow up on national audit findings such as
VBA's accuracy in processing temporary 100 percent disability
evaluations.
After 3 years, and despite VBA concurrence with our audit and
inspection reports, we continue to identify a high rate of VARO errors
in the processing of temporary 100 percent disability ratings. VBA's
efforts to improve accuracy in this area have not been adequate or
timely.
OIG REPORTING ON PROCESSING ACCURACY
Audit of 100 Percent Disability Evaluations
Veterans' disability compensation payments are not usually an
avenue for cost savings. However, 100 percent disability evaluation
processing is one area where systemic problems have led to veterans
receiving long-term payments to which they may not be entitled but not
caused by any fault of their own. Our 2011 national audit detailed our
concerns that VBA paid veterans temporary 100 percent benefits without
adequate medical evidence. We projected that regional office staff did
not correctly process claims for about 27,500 (15 percent) veterans
with 100 percent ratings and that since January 1993 VBA had overpaid
these veterans a net amount of about $943 million. Without timely
corrective action, we conservatively projected that VBA would overpay
veterans $1.1 billion over the period of calendar year 2011 through
calendar year 2015. We noted that once a temporary 100 percent rating
has been in place for 20 years, by law VBA cannot reduce the rating
unless the veteran has committed fraud in obtaining the benefits. The
law, as clarified in VBA's policies, prohibits creating overpayments in
cases involving erroneous awards based solely on VBA administrative
errors or errors in judgment. While these practices rightfully protect
veterans from suffering financial loss due to staff errors, sound
financial stewardship is required to ensure actions are taken to
process accurate payments in the future.
VBA did not agree with all our report findings, particularly as
they related to projected overpayment projection of $1.1 billion over
the next 5 years. We obtained our overpayment estimates through a valid
statistical methodology, which was developed by our Director of Audit
Statistics Division. It was reviewed and approved by the OIG Office of
Healthcare Inspections Director of Biostatistics, who holds a PhD in
statistics.
VBA believed our analysis was skewed and the sample was not truly
random. Our audit focused on those areas that presented the highest
risk to VBA. Therefore, of the 239,000 veterans with at least one
service-connected condition rated 100 percent disabling, we excluded
58,000 veterans from our review because their medical condition was not
likely to improve, such as a double amputee. Our sample is
representative of the stated audit universe of 181,000 veterans. We
selected random samples from the audited universe and properly weighted
projections based on the sample design. The sample design and size was
more than sufficient to allow the assumption of a normal sampling
distribution across the stated universe. In accordance with accepted
sampling procedures, we projected the number of errors and potential
monetary benefits only to the population we reviewed. The report
clearly states that VARO staff did not correctly process evaluations
for about 27,500 (15 percent) of the approximately 181,000 veterans who
might require periodic evaluations. Although the error rates may have
been less had we included the 58,000 veterans in our universe, the
potential monetary benefits could have potentially increased since we
would have projected to a universe of $73 billion instead of $52
billion.
The primary message of our report is VBA paid veterans without
adequate medical evidence and the management of temporary disabilities
needs strengthening. VBA approved significant monthly benefits to
veterans without knowing if the veteran's medical condition warranted
the continued benefit.
VBA agreed to implement our recommendations to:
Improve the electronic system so future medical exam
dates would automatically populate in the electronic system.
Provide training to VARO staff to take appropriate and
timely action on medical examination reminder notifications.
Conduct a review of all temporary 100 percent disability
evaluations and ensure each evaluation has a future medical examination
date entered in the veterans' electronic records.
In response to this last recommendation, the then Acting Under
Secretary for Benefits agreed to review all temporary 100 percent
disability evaluations and ensure each evaluation had a future
examination date entered in the electronic record. Our report stated,
``If VBA does not take timely corrective action, they will overpay
veterans a projected $1.1 billion over the next 5 years.'' The then
Acting Under Secretary for Benefits stated in response to our audit
report that the target completion date for the national review would be
September 30, 2011. VBA subsequently extended the national review
deadline to December 31, 2011, then to June 30, 2012, and then again to
December 31, 2012.
Results from OIG Inspections of VA Regional Offices
Our benefits inspections continue to show that inaccuracy in
processing temporary 100 percent disability evaluations is a systemic
issue. In October 2009 while conducting the national audit, we also
began our VARO Inspections program which includes reviews of the
temporary 100 percent disability evaluations. None of the 53 VAROs we
have inspected since then have fully followed VBA policy in processing
these evaluations. Based on our claims sampling, we determined that
VARO staff did not adequately process temporary 100 percent evaluations
for 1,016 (66 percent) of 1,551 veterans. All 53 \1\ VAROs inspected
had errors, with the Cheyenne Veterans Service Center at the top of the
list with errors in 100 percent of the evaluations we sampled, and the
Des Moines, Iowa, and the Lincoln, Nebraska, VAROs with the best
performance in this area with a processing error rate of 27 percent.
The attached chart shows the accuracy rate of temporary 100 percent
disability evaluations for all 53 VAROs from our first 3-year cycle,
including 2 inspections we have completed since the start of our second
3-year cycle.
---------------------------------------------------------------------------
\1\ The 53 total includes 2 inspections of the VARO in Detroit,
Michigan.
---------------------------------------------------------------------------
These errors often occur when VARO staff fail to input suspense
diaries to VBA's electronic record. A suspense diary is a system
command establishing a future date when VARO staff must determine the
need to schedule an examination to reevaluate a case. As a diary
matures, the electronic system generates a reminder notification to
alert VARO staff to schedule the mandatory reexamination. About 46
percent of the total processing errors we identified since our
inspections began occurred when VARO staff did not input suspense
diaries in VBA's electronic system as mandated by VBA policy. When
there is no reminder to schedule a reexamination, the temporary 100
percent disability evaluation will continue throughout a veteran's
lifetime because nothing calls such cases into question again for
reexamination.
The electronic system works as designed when a reminder
notification is generated, alerting VARO staff to schedule a mandatory
reexamination. However, in 15 percent of the total processing errors,
reminder notifications existed, but VARO staff did not process them, or
they prematurely cancelled the notifications. In these instances, VARO
staff either failed to take the appropriate action to schedule the
medical reexaminations or they removed the diaries prior to the system
generating notifications to schedule medical follow-up.
As a result of the 53 VAROs we assessed for temporary 100 percent
disability evaluations since October 2009, our inspections have
identified a total of just over $15,500,000 in overpayments and almost
$283,000 in underpayments. Where we identify claims processing
inaccuracies, we provide this information to help the VARO improve
future performance. Processing any adjustments based on this review is
solely a VBA management decision.
In response to our inspection reports, VARO Directors concurred
with all of our recommendations to increase process oversight and
provide staff training on the proper procedures for ensuring the
accuracy of temporary 100 disability evaluations. In many VAROs the
recommendations are acted upon during the course of our site visits.
VBA'S CORRECTIVE ACTIONS
VBA efforts have not been aggressive enough to effectively address
this issue. VBA did not provide each VARO with a list of temporary 100
percent disability evaluations for review until September 2011. VBA
subsequently extended the national review deadline multiple times, with
the most current deadline of December 31, 2012. We found some VAROs
still completing their reviews as of January 2013. After 2 years, VBA
is still working to complete this national review requirement. We are
concerned about the lack of urgency in completing this review, which is
critical to minimizing the financial risks of making inaccurate
benefits payments.
We also question VBA's methodology for identifying temporary 100
percent disability evaluations for national review. During several of
our inspections, we identified in our sample data a number of cases
that VBA did not include in the lists it provided to the VAROs for
national review. Upon our review of VBA's methodology, we found it had
several weaknesses that would not ensure as thorough a review as VBA
originally indicated. For example, VBA's methodology excluded certain
claims that had controls in the electronic system to generate reminder
notifications, with the assumption that processing these claims would
therefore be done correctly. We also identified errors associated with
some cases they excluded that, as we found before, related to VARO
staff not taking proper action on reminder notifications or prematurely
cancelling these notifications.
VBA has insisted that system glitches are the reason for many of
the errors related to temporary 100 percent disability evaluation
processing. In June 2011, VBA officials modified the electronic system
to ensure diary dates would automatically populate and remain in the
system without manual entry, specifically for confirmed and continued
(C&C) ratings. For C&C ratings, medical evidence does not necessitate
changing the veterans' existing disability evaluations. For example, a
veteran receives a temporary 100 percent evaluation for prostate
cancer. Medical evidence from the reexamination to determine if the
evaluation should continue shows the veteran still receives treatment
for this condition. Therefore, the Rating Veterans Service
Representative confirms the veteran remains entitled to the temporary
100 percent evaluation and decides to continue the evaluation until the
next required reexamination period, as established by diaries.
Of the total errors we have identified related to suspense diaries,
37 percent involved C&C ratings. We have not tested this system
modification to ensure that the suspense diaries remain in the system.
As such, we have no assurance that it has resulted in a system-wide
correction. However, as part of our inspections, we observed a small
number of recently processed temporary 100 percent disability
evaluations related to C&C decisions and noted that the suspense
diaries stayed in the electronic record. Since the exam dates occur in
the future, we cannot ensure that the electronic system will generate
notifications to alert VARO staff to schedule medical reexaminations as
required.
Further, in August 2012, VBA made a second modification to its
electronic system to ensure that supplemental changes to the electronic
record, such as processing additional claims, would not cause diary
dates to be removed inadvertently from the electronic system. However,
we have not observed this process to offer an opinion on it. Because
OIG Benefit Inspections staff sample completed claims from the prior
quarter, we will not be able to confirm whether this system
modification works until we conduct inspections beginning in late
January 2013 that would examine first quarter FY 2013 data.
Nonetheless, we note that VBA did not make this system modification
until 20 months after our original audit was issued in January 2011.
VBA's focus on system fixes has not addressed the staff errors we
frequently found to be the cause of inadequacies in temporary 100
percent disability evaluation processing. As we proceed with our
benefits inspections, we continue to find processing errors associated
with temporary 100 percent evaluations caused by staff error. For
example, we still find cases where VARO staff do not correctly schedule
medical reexaminations when the system properly generates reminder
notifications. We also continue to disclose problems of staff
prematurely canceling the reminder notifications. Our FY 2012 VARO
inspection reports show 388 (63 percent) of 614 evaluations processed
incorrectly, resulting in 101 overpayments to veterans of approximately
$6.1 million, and 10 underpayments at a cost of $78,000.
CONCLUSION
After 3 years of OIG reporting on inaccuracy issues, VARO error
rates in processing temporary 100 disability evaluations remain
consistently high. While VBA criticizes that our inspections are
narrowly scoped and our claims samples are small, our work is
statistically sound and illustrates a continuing, systemic weakness
that must be addressed.
VBA's efforts to date have not been fully effective in addressing
issues in processing its temporary 100 disability evaluations. VBA has
not been aggressive, timely, or thorough in completing its national
review. While electronic system fixes may resolve some issues, they do
little to address the problem we continue to find with staff error in
processing. As long as VBA delays taking effective action to address
this issue, VA is at risk of underpaying some veterans and repeatedly
overpaying others without proper support thereby diverting millions of
dollars from other important programs for America's veterans today and
into the future.
Mr. Chairman, this concludes my statement. We would be pleased to
answer any questions that you or other Members of the Subcommittee may
have.
ATTACHMENT
Errors in Processing Temporary 100 Percent Disability Evaluations and Associated Overpayments and Underpayments Identified In 53 VARO Inspection
Reports Since 2009
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total Temporary
100 Disability Overpayments Underpayments
53 VAROs (in rank order by percent of errors) Evaluations Total Errors Error Percentage Identified Identified
Reviewed
--------------------------------------------------------------------------------------------------------------------------------------------------------
Cheyenne 7 7 100% $190,458 $0
Los Angeles 30 29 97% $922,886 $0
Waco 30 28 93% $115,255 $7,720
Detroit 30 27 90% $543,399 $1,344
Pittsburgh 30 27 90% $228,712 $0
Houston 30 27 90% $730,768 $0
Honolulu 30 26 87% $197,185 $0
Phoenix 30 26 87% $192,165 $0
Philadelphia 30 25 83% $389,770 $29,969
Boston 30 25 83% $106,133 $0
Louisville 30 25 83% $596,484 $0
Indianapolis 30 25 83% $1,043,400 $1,248
St. Petersburg 30 25 83% $387,252 $0
Albuquerque 30 24 80% $306,162 $0
Jackson 30 24 80% $123,338 $0
Newark 30 24 80% $498,123 $9,743
New Orleans 30 24 80% $431,033 $8,974
Atlanta 30 24 80% $287,067 $2,769
San Diego 30 23 77% $319,255 $20,531
Fargo 30 23 77% $697,010 $3,143
Denver 30 22 73% $757,672 $0
Huntington 30 22 73% $1,254,007 $4,173
Columbia 30 21 70% $440,156 $0
Boise 30 20 67% $307,679 $2,240
New York 30 20 67% $250,087 $0
St. Louis 30 20 67% $117,856 $1,536
Providence 30 20 67% $43,350 $30,626
Montgomery 30 19 63% $117,333 $0
Togus 30 18 60% $39,356 $2,497
Reno 30 18 60% $399,638 $9,930
Hartford 30 18 60% $151,265 $0
Little Rock 30 18 60% $44,250 $0
Detroit* 30 18 60% $231,436 $16,515
Manila 14 8 57% $177,152 $13,936
Seattle 30 17 57% $97,981 $0
Buffalo 30 17 57% $124,552 $45,356
Muskogee 30 16 53% $0 $9,874
Portland 30 16 53% $137,262 $0
Cleveland 30 16 53% $561,519 $8,175
Salt Lake City 30 16 53% $113,834 $11,674
Oakland 30 16 53% $284,256 $1,223
Wichita 30 16 53% $134,210 $0
St. Paul 30 15 50% $239,453 $6,204
White River 30 15 50% $531,825 $0
Winston-Salem 30 15 50% $87,513 $1,152
Anchorage 30 15 50% $139,177 $19,220
Manchester 30 14 47% $66,550 $0
Milwaukee 30 14 47% $100,824 $0
Chicago 30 13 43% $40,275 $12,414
Ft. Harrison 30 10 33% $2,823 $0
Sioux Falls 30 9 30% $61,606 $0
Des Moines 30 8 27% $415,648 $0
Lincoln 30 8 27% $17,241 $0
Totals 1,551 1,016 66% $15,793,641 $282,186
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*Note: Overpayment and underpayment dollar amounts are not included
in the published Detroit VARO inspection report. Also, Detroit is also
the only VARO listed that we have inspected twice since 2009.
Prepared Statement of Hon. Diana Rubens
Good morning Chairman Runyan, Ranking Member Titus, and Members of
the Subcommittee. Thank you for the opportunity to discuss the Veterans
Benefits Administration's (VBA's) administration of the temporary 100-
percent disability rating. We recognize the critical importance of
providing this benefit to our Veterans, which allows them to receive
compensation at the 100-percent rate during the times they are most in
need. We also recognize our obligation to ensure proper administration
of the benefit to Veterans and good stewardship of taxpayers' dollar.
Temporary 100-Percent Disability Rating
VA regulations authorize a 100-percent disability rating under
specific criteria tied to individual disabilities, or when any service-
connected impairment of mind or body makes it impossible for a Veteran
to pursue a substantially gainful occupation. These 100-percent
disability ratings can be granted on either a temporary or permanent
basis. VBA grants a permanent rating if medical evidence shows the
Veteran's total disability is not likely to improve. The 100-percent
disability rating is generally held to be permanent when no routine
future examination is warranted. Additionally, if a 100-percent rating
has been in place for 20 years, VBA cannot reduce the rating unless the
Veteran committed fraud in obtaining the benefits.
Temporary 100-percent disability ratings are often awarded when
service-connected disabilities require complex surgery, convalescence,
or specific inpatient or intense treatment, such as radiation or
chemotherapy in the case of most cancers. At the end of a mandated
period of convalescence or following cessation of treatment, VBA is
responsible for reviewing the Veteran's medical condition to determine
whether to continue the temporary 100-percent rating. Generally,
medical examinations are required if there is potential for improvement
in a disability that might lead to a decreased disability rating. If a
medical examination shows material improvement in the Veteran's
condition, and VBA determines that a reduced rating is necessary, then
VBA initiates action to reduce benefits. When VBA proposes a reduction
in benefits, the beneficiary is notified that he or she has 60 days to
submit additional evidence and/or request a pre-reduction hearing.
National Audit of 100-Percent Disability Ratings
On January 24, 2011, the Department of Veterans Affairs (VA) Office
of Inspector General (OIG) released the report of its audit of
temporary 100-percent disability ratings. The audit examined two areas:
whether VBA regional offices (ROs) correctly assigned 100-percent
disability ratings as either permanent or temporary and whether ROs
effectively monitored and reevaluated temporary 100-percent disability
ratings.
The audit found that temporary 100-percent disability ratings were
not being correctly monitored for reevaluation. The OIG identified
three primary causes: Staff did not (1) enter future medical
examination dates into VBA's electronic records; (2) monitor automated
notifications entered into VBA's electronic records; and (3) comply
with VBA regulations that require ROs to ensure a Veteran's condition
was not likely to improve before assigning permanent evaluation.
The OIG made seven recommendations, including a recommendation that
VBA review all temporary 100-percent disability ratings to ensure each
evaluation had a future examination date entered in the Veteran's
electronic record. VBA agreed to implement all of the recommendations.
System Problem in Future Examination Processing
In September 2010, during the course of the OIG audit, VBA
identified a system software problem that was causing many properly
established future examination dates to drop out of the system,
contributing significantly to the problems being identified by the OIG.
VBA found that the premature removal of future examination dates
occurred in three scenarios. Without these future dates in the system,
our employees did not receive notification to schedule these Veterans
for medical examinations to reevaluate their conditions. After
extensive analysis, VA determined that the complexity of the system
requirements for future examination processing required a complete
redesign of that system functionality.
VBA completed business requirements for the redesign, and new
system functionality for future-examination processing was deployed on
July 2, 2012. This redesign successfully corrected the previously
identified system defects.
VBA Review of Temporary 100-Percent Ratings
VBA conducted three separate claims reviews while system changes
were being made to ensure future-examination dates were properly
recorded for temporary 100-percent ratings and to schedule medical
examinations for those Veterans who were overdue for reevaluation. VBA
established a system control for each identified record so corrective
action could be taken.
In the course of the reviews, VBA continued to identify cases that
were not under proper control to be tracked for completion of all
required actions - either because proper corrective action had not yet
been taken or had been taken prior to July 2012 and the future date had
again dropped from the system. To address this concern, a backup
process was put in place to identify cases without a future examination
date established and require review of these cases to either establish
a future date or ensure the rating decision correctly documented that
the 100-percent rating had been established as permanent.
Because the input of future-examination dates remains a manual
input process in VBA's current legacy processing system, VBA is now
conducting this backup process every two weeks to ensure that all 100-
percent ratings are appropriately identified in our system as either
temporary (with a future examination scheduled) or permanent.
Training on Future Examination Processing
VBA also continues to provide extensive training for claims
processors on inputting future exams:
Future examination training is provided to all new claims
processors during the initial training for new claims processors, known
as Challenge training.
Since fiscal year (FY) 2010, Rating Veterans Service
Representatives (RVSRs) have been required to complete the training
lesson plan on Rating Reductions. This lesson plan addresses the use of
future examinations.
In January 2011, Compensation Service amended the
mandatory ``Matching Programs'' training lesson plan for Veterans
Service Representatives (VSRs). This amended training lesson provides
claims processors with instructions on the appropriate actions to take
when processing claims with future examination dates. Supplemental
material regarding future examinations was provided in mandatory
National Core Curriculum training for all VSRs.
In March 2011, a lesson on permanent and total ratings
was mandated for all RVSRs. This lesson included information concerning
the establishment of future examination dates.
In March 2012, Compensation Service created a mandatory
lesson plan on ``Inferred Issues'' for RVSRs that focuses on
determining when a future examination is required. The training
provides an additional reminder to the field to ensure that future
examination dates were not omitted from the award.
In June 2012, Compensation Service released two mandatory
training lessons for RVSRs. These were entitled ``Effective Dates'' and
``Subordinate Issues'' and were required training during FY 2012. Both
of these lessons address the proper use of future examinations.
VBA Transformation
VBA is in the midst of implementing a series of tightly integrated
people, process, and technology initiatives designed to eliminate the
claims backlog and achieve our goal of processing all claims within 125
days at a 98-percent quality level in 2015. VBA is developing and
deploying technology solutions that drive automation of the claims
process. Our new paperless processing system, the Veterans Benefits
Management System (VBMS), is employing rules-based functionalities that
will allow VBA to more effectively monitor and timely adjust temporary
100-percent ratings.
VBMS software requires the decision-maker to either establish the
permanency of the 100-percent rating or establish a future examination
diary. Once VBMS is in place nationwide, these rule sets will ensure
compliance with business rules and procedures associated with 100-
percent ratings.
Estimated Overpayments
Based on the audit findings, the OIG projected that VBA has paid
Veterans a net amount of $943 million without adequate medical evidence
since January 1993. Further, the OIG projected that if corrective
action was not taken, VBA would overpay Veterans another $1.1 billion
over the next five years. VBA believes the overpayment projection of
$1.1 billion over the next five years is significantly overstated.
VBA believes OIG's overall error rate in the report of 15-percent
is overstated. OIG reduced the population from which to sample by
approximately 58,000 Veterans with conditions that clearly indicated no
likelihood of improvement, such as double amputees. VBA believes that
removing 58,000 presumed error-free cases skewed the analysis and
caused sampling to no longer be truly random.
VBA reviewed records for eight of the top overpayments that were
identified by the OIG, and found that three of these cases (38-percent)
still warranted 100-percent ratings or payment at the 100-percent rate.
Therefore, potentially 38 percent of the errors used to make monetary
projections may not be valid.
Nevertheless, VBA agrees that significant overpayments were
occurring as a result of not timely reevaluating all cases with 100-
percent temporary ratings.
Conclusion
VBA is committed to providing timely and accurate payments to
Veterans while ensuring proper stewardship of taxpayers' dollar. VBA
has already taken significant corrective actions (including case
reviews, legacy system software changes, mandatory training, increased
oversight, and technology enhancements in our new VBMS paperless
processing system currently being deployed) to ensure temporary 100-
percent ratings are effectively monitored and adjusted. At the same
time, we acknowledge that our regional offices have not yet completed
action on all of the individual cases requiring review. We will
continue to carefully monitor these cases to completion and partner
with OIG to ensure we are providing our Veterans with timely and
accurate benefit payments. Mr. Chairman, this concludes my statement. I
would be pleased to answer any questions you or other Members of the
Subcommittee may have.
Statement For The Record
Mr. Carl Blake, National Legislative Director, Paralyzed Veterans
of America
Chairman Runyan, Ranking Member Titus, and members of the
Subcommittee, Paralyzed Veterans of America (PVA) would like to thank
you for the opportunity to offer our views on the Department of
Veterans Affairs (VA) use of the 100 percent temporary total disability
rating. First, we must emphasize that this type of rating is rarely
used for the veterans that PVA serves through our national service
staff. When we file claims on behalf of our members--veterans with
spinal cord injury or disorder--and other catastrophically disabled
veterans, their final decision generally is a permanent and total
rating.
That being said, temporary total disability ratings serve an
important and practical purpose for many veterans. The determination
for temporary total disability ratings are governed by the provisions
of 38 C.F.R. Sec. 4.29, Ratings for service-connected disabilities
requiring hospital treatment or observation, and 38 C.F.R. Sec. 4.30,
Convalescent ratings. Temporary increases to VA disability ratings in
accordance with the provisions of Paragraphs 29 and 30 are simple
adjustments to running compensation awards that can be accomplished by
employees with a minimum of training. Temporary increases to
compensation Paragraph 29 are determined by the verified dates of
hospitalization. Meanwhile, adjustments under the provisions of
Paragraph 30 are established by rating action based on available
medical information. In each case, the dates of entitlement are clearly
indicated, and with only a small amount of attention to detail, there
should be no significant errors.
In January 2011, the VA Office of the Inspector General (OIG)
published a report entitled ``Veterans Benefits Administration, Audit
of 100 Percent Disability Evaluations'' (Report #: 09-03359-71, January
24, 2011). In that report, the OIG examined approximately 181,000
veterans claims rated with a total disability. Of that number,
approximately 11,800 (reported as 43 percent of 27,500 claims that were
determined to have errors) of those claims were for temporary total
disability that the OIG determined contained errors. OIG concluded that
this had led to overpayments of nearly $943 million with a potential
overpayment of approximately $1.1 billion in the next five years.
Unfortunately, the OIG report fails to address the cost of the loss of
benefits when veterans with total disabilities were underpaid.
PVA has also reviewed the findings of the recent report
``Inspection of the VA Regional Office (VARO), Anchorage, Alaska
(Report #: 12-02089-60, January 3, 2013) from the VA Office of the
Inspector General (OIG). In the report, the OIG concluded that the
Anchorage VARO lacked effective controls and accuracy in processing
some disability claims. Specifically, 50 percent of the 30 temporary
total disability evaluations reviewed were inaccurate. The OIG
attributed these errors to staff that did not establish controls to
monitor proposed reductions, or schedule future medical reexaminations
as required to determine whether to continue these evaluations.
The remaining errors identified in the Anchorage report for
processing temporary total disability evaluations involved Veterans
Service Center staff not:
Scheduling routine future medical reexaminations as
required,
Requesting the necessary medical examination, and
Timely scheduling hearings for veterans to present
evidence in response to proposals to reduce their benefits.
PVA is especially troubled by the fact that these findings are not
substantially different from those included in the OIG report from
January 2011.
Unfortunately, the overriding concern emphasized by the OIG in both
reports is the increased risk of paying unnecessary compensation
benefits. In the most egregious case outlined in the Anchorage report,
the VARO staff did not schedule a medical reexamination to evaluate a
veteran's breast cancer. However, VA medical records showed the veteran
had completed treatment, which should have resulted in a reduction in
benefits. Because a follow-up medical reexamination was not scheduled,
VA continued processing monthly benefits for temporary total disability
and ultimately overpaid the veteran $96,135 over a period of 5 years
and 11 months. The report from January 2011 outlined occurrences that
were far worse than that scenario.
PVA is concerned that this issue is being framed as wasteful
spending on the part of VA. While we do not dispute the findings of the
OIG report regarding overpayment of compensation under the rules for
temporary total disability ratings, we believe the Committee should
similarly examine the VA's failure to provide these benefits in a
timely manner or decisions to not grant the maximum entitlement. Too
often, an individual can wait for months while convalescing to receive
the increase to his or her compensation for temporary total disability.
This delay in payment of benefits can put a serious financial strain on
a veteran who might be unable to work during that convalescence period.
In fact, the OIG identified a case where the VARO staff did not grant a
veteran entitlement to an additional special monthly benefit based on
evaluations of multiple disabilities, as required. As a result, VA
underpaid the veteran a total of $19,220 over a period of 5 years and 1
month.
Documentation of major discrepancies in determinations for
temporary total disability indicates that much larger problems
apparently exist in training and evaluation. The discovery of such
fundamental and egregious errors that have been ongoing for a ten year
period can only be construed as an indictment of a failed training
program and failed management practices. If VA employees cannot
successfully perform the most basic claims processing functions, what
should we expect when they engage the more complex aspects?
First line supervisors must be capable of evaluating the skills and
needs of their subordinates, but responsibility cannot stop there. Mid-
level and higher management also must bear part of the responsibility.
From our perspective, we see front line VA employees that are beaten
down by their supervisors under the guise of quality control. STAR
reviews, and similar measures, are constantly in pursuit of errors in
an effort to improve overall quality. Unfortunately, the result all too
often is an intensified focus on the process, and not the outcome.
Mr. Chairman, we would like to thank you once again for allowing us
to address this issue. We hope that by highlighting this issue, VA will
make meaningful reforms to ensure that errors are corrected, that
appropriate steps are taken when processing temporary total disability
claims, and that veterans receive the correct benefits in a timely
manner.
PVA would be pleased to take any questions for the record.
Information Required by Rule XI 2(g)(4) of the House of Representatives
Pursuant to Rule XI 2(g)(4) of the House of Representatives, the
following information is provided regarding federal grants and
contracts.
Fiscal Year 2013
No federal grants or contracts received.
Fiscal Year 2012
No federal grants or contracts received.
Fiscal Year 2011
Court of Appeals for Veterans Claims, administered by the Legal
Services Corporation--National Veterans Legal Services Program--
$262,787.