[Senate Hearing 113-040]
[From the U.S. Government Publishing Office]
S. Hrg. 113-040
VA CLAIMS PROCESS: REVIEW OF VA'S TRANSFORMATION EFFORTS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
MARCH 13, 2013
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.fdsys.gov
----------
U.S. GOVERNMENT PRINTING OFFICE
80-110 PDF WASHINGTON : 2013
COMMITTEE ON VETERANS' AFFAIRS
Bernard Sanders, (I) Vermont, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Johnny Isakson, Georgia
Sherrod Brown, Ohio Mike Johanns, Nebraska
Jon Tester, Montana Jerry Moran, Kansas
Mark Begich, Alaska John Boozman, Arkansas
Richard Blumenthal, Connecticut Dean Heller, Nevada
Mazie Hirono, Hawaii
Steve Robertson, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
----------
March 13, 2013
SENATORS
Page
Sanders, Hon. Bernard, Chairman, U.S. Senator from Vermont....... 1
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 3
Tester, Hon. Jon, U.S. Senator from Montana...................... 5
Heller, Hon. Dean, U.S. Senator from Nevada...................... 5
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 6
Begich, Hon. Mark, U.S. Senator from Alaska...................... 33
Moran, Hon. Jerry., U.S. Senator from Kansas..................... 38
Johanns, Hon. Mike, U.S. Senator from Nebraska................... 45
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 49
WITNESSES
Hickey, Allison A., Under Secretary for Benefits, Veterans
Benefits Administration, U.S. Department of Veterans Affairs;
accompanied by Stephen Warren, Acting Assistant Secretary,
Office of Information and Technology; and Alan Bozeman,
Director, Veterans Benefits Management System Program Office... 6
Prepared statement........................................... 9
Response to posthearing questions submitted by:
Hon. Bernard Sanders....................................... 17
Hon. Richard Burr.......................................... 18
Hon. Mark Begich........................................... 19
Hon. Mazi Hirono........................................... 22
Response to request arising during the hearing by Hon.
Richard Burr............................................... 28
Bertoni, Daniel, Director, Education, Workforce, and Income
Security, U.S. Government Accountability Office................ 52
Prepared statement........................................... 54
Thompson, Joseph, Project Director, National Academy of Public
Administration and Former Under Secretary for Benefits, U.S.
Department of Veterans Affairs................................. 73
Prepared statement........................................... 75
Stichman, Bart, Joint Executive Director, National Veterans Legal
Services Program............................................... 81
Prepared statement........................................... 82
Violante, Joseph, National Legislative Director,
Disabled American Veterans..................................... 85
Prepared statement........................................... 86
VA CLAIMS PROCESS: REVIEW OF VA'S TRANSFORMATION EFFORTS
----------
WEDNESDAY, MARCH 13, 2013
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 10:02 a.m., in
room 418, Russell Senate Office Building, Hon. Bernard Sanders,
Chairman of the Committee, presiding.
Present: Senators Sanders, Tester, Begich, Burr, Isakson,
Johanns, Moran, and Heller.
OPENING STATEMENT OF HON. BERNARD SANDERS,
CHAIRMAN, U.S. SENATOR FROM VERMONT
Chairman Sanders. The Senate Committee on Veterans' Affairs
hearing is going to begin.
We are glad to see Senator Isakson with us. As I understand
it, Senator Burr will be here later. OK. We have the Senator
from Montana here as well, Jon Tester. I think we will see
Senators coming in and out. This is a busy time in the Senate.
We want to thank our panelists for being with us for this
important hearing.
Let me begin by saying that during the last several weeks,
the Veterans' Committees in the House and the Senate have held
four hearings including virtually all of the veterans'
organizations.
During their testimonies, the organizations raised a number
of issues, but I think it is fair to say that the number 1
issue they raised, the number 1 concern that they have and a
concern that many of us on this Committee share is that the
most pressing problem within the VA now is the very significant
backlog that we have in processing claims for our veterans.
That is the number 1 issue I believe that the service
organizations believe is out there. It is my concern as well,
being the number 1 issue facing the VA, which is why the very
first hearing that we are having since I have become chair of
this Committee will address this issue.
My understanding is that as of March 2, 2013, 70 percent of
the compensation and pension inventory of 895,000 claims have
been pending for over 125 days. Further, the accuracy rate of
86 percent at the end of fiscal year 2012 is significantly
lower than what must be accomplished.
In addition, such agencies as the GAO and the VA's own
Inspector General have raised some very, very serious concerns
about the work and efforts that the VA is undertaking in
addressing the claims processing crisis.
It is my view, and I believe that I speak for every Member
of this Committee, that when men and women put their lives on
the line to defend this country, they must be treated with
dignity and respect when they return; not with red tape, not
with bureaucracy, not with, in some cases, years of delay
before they get the benefits to which they are entitled.
Without being overly dramatic here, we all know that one of
the tragedies facing the veterans' community right now is that
22 veterans every single day are committing suicide, and I know
that no one in the VA and no one in the Congress wants to add
to that problem, wants to add to the frustration and the
problems that veterans have by delaying the benefits to which
they are entitled.
That is the bad news; and those are some very, very serious
problems that we are going to be discussing today. We look
forward to the testimony of our panelists.
Here is some better news--it is important to put this issue
in a broader context. Despite, I believe, a popular
misconception, as I understand it, the VA today is processing
far more claims than they have ever processed before.
So, this is not a case of the VA system falling apart and
being unable to process claims. In fact, they are processing
more claims today, significantly more than they have ever
processed before.
As I understand it, in 2001, the VA completed some 480,000
claims. In 2002, about 796,000 claims. In 2003, 827,000 claims.
During the last 3 years, the VA has processed over one million
claims in each of those years.
Further, it is generally believed that the VA did exactly
the right thing--and I want to thank General Shinseki and the
VA for doing this--making certain that Vietnam veterans who
were exposed to Agent Orange and became ill as a result of that
exposure, finally after years and years of delay, get the
benefits that they were entitled to.
In the last several years, the VA has processed some
278,000 new claims for Agent Orange. It is generally believed
that they had done a pretty good job in processing those claims
and doing it in a timely manner.
My last point. General Shinseki has set a very, very
ambitious goal in terms of eliminating the backlog by 2015 and
of having the VA process compensation claims so that no veteran
or eligible spouse or child has to wait more than 125 days for
a quality decision, meaning a 98-percent accuracy rate on
claims.
I think we can all agree that that is a very, very
ambitious goal. Obviously, the subject of today's hearing is
whether or not we are going to achieve that goal.
Let me conclude. Later on today we are going to hear
testimony from Joe Violante who is with the Disabled American
Veterans. The DAV, as I understand it, probably helps more
veterans process claims than any other organization in the
country.
What Mr. Violante is going to tell us is that the DAV
believes that the VBA, with the work that the VA is now doing,
is on the right path, that they have set the right goals, and
that they have leadership committed to transforming and
institutionalizing a new claims processing system to better
serve veterans.
That is more or less the testimony that we heard from the
veterans' service organizations during the House/Senate
legislative presentation hearings. The understanding that it is
absolutely imperative that we move away from the paper system
and into the 21st century where we have a paperless system; and
there is the belief, I think, from the veterans' community that
we are moving in the right direction, but that many, many
problems remain which must be addressed.
So, that is kind of where we are right now. I look forward
to hearing the testimony.
Now, let me give the mic over to Senator Isakson, who will
be acting as Ranking Member until Senator Burr comes.
Senator Isakson.
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. Well, thank you, Chairman Sanders, and
thank you for your vigilant effort on what is the number 1
challenge facing the VA and the number-one frustration facing
every American veteran returning home.
I want to thank our witnesses for coming to testify today
and welcome all in the audience for this hearing.
As you know, the VA claims process has been plagued by
errors, delays, and backlogs for many years. The latest
examples to fix this system are: VA has hired thousands of
claims processing staff; spent millions of dollars developing
new IT solutions; and rolled out dozens of other initiatives.
But, as the charts to your left indicate, this is yet to
translate into better service for veterans, families, and their
survivors.
On chart one, over 4 years the number of claims waiting for
a decision grew from less than 400,000 to nearly 850,000. Today
it is even higher. The number of claims considered part of the
backlog more than tripled.
On chart two, you will notice the accuracy rate of VA
decisions remained in the mid-80s, as Chairman Sanders referred
to. The time it takes to process a claim has increased by 83
days, which is continuing to trend upward.
As chart three shows, if someone disagrees with VA's
initial decision, it takes an average of 866 days for VA to
decide the appeal, 7 months longer than in 2008.
Despite these trends, VA leaders say they are on track to
eliminate the entire backlog and raise quality to 98 percent by
2015. In fact, the VA recently released a backlog reduction
plan which reflects that VA aims to increase productivity by
about 80 percent over the next 2 years.
Perhaps more challenging, VA would need to significantly
reduce its error rates while deciding hundreds of thousands of
cases of additional claims each year. To gauge how realistic
this may be, we should look at how well the VA has predicted
its performance in recent years.
For example, in 2011 and 2012, VA completed about 412,000
fewer claims that had been projected. Last year VA estimated
that during the current fiscal year, no more than 40 percent of
claims would be backlogged and claims would be decided with 90
percent accuracy in about 200 days. But today it takes 280 days
for an initial decision. VA makes errors in 14 percent of the
cases and 70 percent of claims are backlogged.
If you look at chart four, in addition, there has been a
shift in VA projections about when we should see results from
initiatives to improve claims' processing.
Back in 2010, we were told that those efforts would begin
to yield results in 2011. As the chart shows, VA then projected
that it would begin to reduce the backlog in 2012. Now, the VA
expects the backlog to continue to grow until 2014.
Also, in estimating the work that VA would need to do to
eliminate the backlog, it appears VA did not take some factors
into account, such as resisting laws that continue to increase
the number of claims coming in. This was referred to by
Chairman Sanders in his remarks.
On top of that, both the Inspector General and the
Government Accountability Office have raised concerns about
VA's ability to improve accuracy and timeliness, highlighting
that the new IT system only partially functioned and that there
were weaknesses in VA's planning documentation. We have heard
some veterans' organizations expressed doubt about VA and
whether it will reach its goal by 2015.
Given all of this, we cannot simply wait until 2015 to see
if the VA initiatives worked. We need to make sure the VA has a
realistic plan to begin improving timely, accurate decisions to
anyone who is seeking veterans' benefits.
If VA is not on track to do that, we must look at what can
be done to make sure that there are not 2 years of discussion
or, even worse, not 2 years more of discussion and continued
delay in claims.
To that end, VA must be completely transparent about what
is working, what is not, and where changes are needed to bring
about lasting improvement.
I want to make a personal comment here after reading
Senator Burr's speech because he is a little late and I am
happy to do so.
I have run a company, Chairman Sanders, for 22 years,
during that period of time where most businesses in America
converted from a paper and pencil operation to high-tech
Internet technology.
It is hard to do. I screwed up more times than I succeeded.
But once I learned how hard that was going to be to do, I
planned for those problems and tried to manage the system
transition so that it had the least affect on my employees and
my salespeople and their performance.
I hope the VA will be honest in evaluating what its new IT
system will and will not do, planning for the problems that
always come about and making sure that the number 1 goal is to
see to it the least affected persons are the veterans of the
United States military.
Mr. Chairman, thank you for calling the hearing. I look
forward to working with you and the Veterans Administration on
improving the backlog.
In Georgia, I will tell you claims is the number 1
challenge for my office, and I will continue to stay on this
until it is done.
Chairman Sanders. Thank you for much, Senator Isakson.
Senator Tester.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman. I want to say,
first of all, thanks for having this hearing. Second,
congratulations on the new position. I look forward to working
with you and hopefully I will continue to call you Chairman
Sanders for a long time and not Bernie. OK.
I also want to welcome the new Members, Senators Heller,
Hirono, and Blumenthal. I look forward to their contributions
to this Committee. It seems like every time I go to a Committee
meeting and look across the way to Senator Heller sitting
there. We have very similar Committee assignments.
I also want to thank the witnesses. I want to thank you for
the work that you have done and I want to thank you for the
work you are going to do. It is not an easy issue.
I think the first hearing we had in 2007, if not the first
one, one shortly thereafter, dealt with the backlog issue. It
has been going on much, much too long.
You do not have an easy job. I think to get folks into the
system and to do it accurately--making sure the folks who are
trying to game the system do not take money away from the
people who need it--is difficult but it needs to be done, and
it needs to be done in a better, more timely manner than we
have done so far.
You know, the average Vietnam veteran had three to five
injuries when filing for their VA claim. Now, I think it is
closer to more than a dozen when new claims are being filed.
We need to move forward in a better way. We need to have an
open conversation on how to get that done, and we need to know
if we are on the right path.
As these wars wind down, that will be good thing as far as
the pressure on you. Right now, though, we are just treading
water. If we are doing a little better than that, you will have
to tell me. It does not appear so, and we need to know what is
working and have an honest discussion on that.
With that, I just say thank you folks for your work once
again. I look forward to your testimony.
Chairman Sanders. Senator Tester, thank you very much.
Senator Heller.
STATEMENT OF HON. DEAN HELLER,
U.S. SENATOR FROM NEVADA
Senator Heller. Thank you, Mr. Chairman. Thank you for
giving us the opportunity to discuss this issue.
I agree with Senator Isakson that this is an issue that I
hear a lot about. Even as recent as last night, I got a phone
call from a woman in Reno who's husband has an Agent Orange
issue and has been delayed for over a year and one-half. With
the backlog of claims, they have concerns.
I will be really brief here, Mr. Chairman. But I understand
how difficult this is; I really do understand how difficult it
is. When I was Secretary of the State of Nevada, when I first
walked into the office, I walked into a vault that had all the
records of every company ever established in the State of
Nevada all the way back to 1864, and it was all on microfiche.
We are talking hundreds of thousands of records, companies, so
on and so forth, and there was only one person who knew how to
find the record that we needed that day.
It was a very, very difficult process. It was key in that
office to take that fiche and move it to disk. Once we got it
on a disk, we got it Internet based, and we made that
transition over 3 or 4 years which was not easy. Believe me, I
understand how difficult this process can be, but you plan and
you plan.
I am concerned, as everybody else here on this Committee
is, the fact that we have 10,000 claims backlogged right now in
Nevada.
And the concern from every organization that has come
before this Committee is that we are not going to meet that
2015 deadline or the goal from the Secretary in order to
eliminate this backlog.
So anyway, I want to hear answers. I have some questions. I
look forward to the questions but I, first of all, want to
thank you for being here and for taking your time.
Mr. Chairman, thank you for the opportunity.
Chairman Sanders. Thank you, Senator Heller.
Senator Burr.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Mr. Chairman, thank you. I thank you.
Welcome, Ms. Hickey.
Since Senator Isakson has already given my opening remarks,
I will yield the floor to the chair.
Chairman Sanders. Thank you very much.
OK. We are ready to hear from our panelists. We are going
to begin with General Allison Hickey, who is the Under
Secretary for Benefits at the Department of Veterans Affairs.
General Hickey is accompanied by Stephen Warren, the Acting
Assistant Secretary for the Office of Information and
Technology, and Alan Bozeman, the Director of the Veterans
Benefits Management System Program Office.
General Hickey, welcome and please begin.
STATEMENT OF ALLISON A. HICKEY, UNDER SECRETARY FOR BENEFITS,
VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS; ACCOMPANIED BY STEPHEN WARREN, ACTING ASSISTANT
SECRETARY, OFFICE OF INFORMATION AND TECHNOLOGY; AND ALAN
BOZEMAN, DIRECTOR, VETERANS BENEFITS MANAGEMENT SYSTEM PROGRAM
OFFICE
Ms. Hickey. Thank you. Good morning, Chairman Sanders,
Ranking Member Burr, and Members of the Committee.
Thank you for the opportunity to discuss VBA's
transformation efforts. I am accompanied today, as you have
already said, by Mr. Stephen Warren, Acting Assistant Secretary
for Information and Technology, and Mr. Alan Bozeman, to my
right, the Director of the Veterans Benefits Management System
Program Office.
As a direct result of the support this Committee has
provided, VBA is completing more compensation claims than ever
before in VA history, over 3 million in the past three fiscal
years and three times the amount since 2001 when this latest
conflict began.
Yet, despite these efforts, too many veterans still have to
wait too long to get the compensation benefits they have
earned, and that is unacceptable to us.
My testimony today will focus on how execution of our
transformation plan will allow VBA to eliminate the backlog in
2015. I would first like to discuss the inventory of claims and
the factors impacting our timeliness.
The current inventory represents claims from veterans of
all eras. The largest percentage of claims comes from our
Vietnam-era veterans who make up 37 percent of our inventory
and backlog. 1990s Gulf War-era veterans make up 23 percent,
while veterans of the Iraq and Afghanistan conflicts today make
up only 20 percent of that inventory and backlog. Our World War
II- and Korea-era veterans make up less than 10 percent.
The inventory contains original claims, those submitted by
veterans who are claiming disability compensation from VA for
the very first time, and supplemental claims from veterans who
have previously filed and are seeking additional benefit.
As of January, 61 percent of the inventory are supplemental
claims or second filers; 39 percent are original first-time
filers.
These percentages hold true for the backlog as well. Of
those veterans filing supplemental claims, 78 percent are
currently receiving a monetary benefit from VA; 40 percent of
veterans filing supplemental claims have a disability rating
between 50 and 100 percent, receiving payments from $1,000-
$2,800 monthly.
In all, about half of the veterans in the total inventory
are already receiving some level of compensation from VA. What
is clear is the demand for this benefit is at an all-time high.
We have added more than 940,000 veterans, almost 1 million
veterans to the VA compensation rolls by completing their claim
over the past 4 years which is more than today's active-duty
Army and Navy combined.
Coupled with this increase are the impacts of claims
associated with Agent Orange exposure and the dramatic increase
in the number of individual medical issues included inside each
claim. The bottom line, these claims are substantially more
complex by more than 180 percent yet we still have done 27
percent more of these claims today than in 2009.
In 2009, Secretary Shinseki made the decision to add three
presumptive conditions for Vietnam veterans who were exposed to
the herbicide Agent Orange. Over the next two and half years,
VBA dedicated over 2300 of our most experienced claims staff,
about 37 percent of our workforce, to re-adjudicate these
claims for these conditions that were previously denied.
By October 2012, we had completed all 260,000 Agent Orange
claims and paid over $4.5 billion in retroactive benefits to
over 164,000 Vietnam veterans and their survivors.
While the decision was absolutely the right thing to do, it
did have an impact on our ability to keep up with new claims
coming in and on aging claims already in the system.
Another key factor is the increase in complexity of the
claims themselves. There has been a 200 percent increase over
the last 10 years in original claims containing eight or more
medical issues.
From 2009 to 2012, the number of medical issues inside the
claims increased from 2.7 million to over 4 million, a 50
percent growth in medical issues which is a truer measure of
the time it takes to complete a claim.
It is having a significant impact on our production, the
growth in our inventory, and the timeliness of claims
processing. Given a growing demand and complexity of our
claims, it is clear to us that continuing a legacy approach in
paper will not meet the needs of our veterans.
I am happy to report that we have achieved momentum with
our transformation plan that will improve how veterans'
benefits are delivered for generations to come, and 2013 is the
year of full deployment and change for us.
Our transformation with its people, process, and technology
initiative represents the single, largest reinvention of VBA in
all of its history. Our focus is on managing that change while
sustaining production and improving quality.
VBA's employees are key to transformation success. Over 52
percent of them are veterans themselves, and we have a work
force that we have reorganized into new cross-functional teams,
new segmented claims--express, special ops and cores--and after
60 days in this new organizational model, overall productivity
per claims rater has increased by 17 percent.
The productivity of the work force and the accuracy of our
decisions are being increased through new national training
programs and standards. There are 2150 new employees who have
received our new challenge training that now decide 150 percent
more claims in their first 6 months on the job with a 30
percent increase in their quality.
Through process improvement teams, we have conducted rapid
development, testing and launch of process initiatives like
simplified notification letters, disability benefit
questionnaires, acceptable clinical evidence, fully-developed
claims and automated processing tools which are showing
positive results with increased implementation.
The Veteran Benefit Management System, or VBMS, is a web-
based electronic claims processing solution that serves as our
technology platform for quicker, more accurate processing.
National deployment of the first generation of VBMS to our
regional offices began in late 2012 and is now in full swing
with the 28 January 2013 release.
We also now have end-to-end digital filing capability from
portal to decision. With integration of the online portal
eBenefits system with VBMS, veterans can now file a claim
online using a ``TurboTax''-like system to upload their own
evidence to support their claim.
Chairman Sanders. General Hickey, summarize please.
Ms. Hickey. I will absolutely.
We will continue to pursue our plan and our initiatives of
the direct and absolute imperative to improve delivery of
benefits to our veterans, their families, and survivors. They
deserve that from us. We are committed to make that happen, Mr.
Chairman.
[The prepared statement of Ms. Hickey follows:]
Prepared Statement of Allison A. Hickey, Under Secretary For Benefits,
Veterans Benefits Administration, U.S. Department of Veterans Affairs
Good morning, Chairman Sanders, Ranking Member Burr, and Members of
the Committee. Thank you for the opportunity to discuss VA's benefits
claims transformation efforts. I am accompanied today by Mr. Stephen
Warren, Principal Deputy Assistant Secretary for Information and
Technology, and Mr. Alan Bozeman, Director of the Veterans Benefits
Management System (VBMS) Program Office.
As a direct result of the budget support provided by the Committee,
VBA has completed more than one million disability compensation claims
the last three years in a row--the highest numbers ever in the history
of VA. Despite this stride, too many Veterans wait too long to get the
benefits they have earned and deserve. My testimony today will focus on
how execution of our Transformation Plan will allow VBA to meet the
Secretary's goal of claims completed in 125 days at a 98 percent
accuracy level in pursuit of eliminating the claims backlog in 2015.
meeting the needs of veterans
Veterans, their family members, and Survivors deserve our very best
performance and the ability to deliver an array of benefits and
services that Veterans have earned--faster, more accurately, and with
greater efficiency and effectiveness. It is the growing inventory of
disability claims, and our need to quickly process those claims, that
is driving the urgency with which we are advancing our Transformation.
VBA completed over one million claims per year in fiscal years
2010, 2011, and 2012. Yet the increased productivity in claims
processing was not enough to keep pace with the number of claims
received in several of those years. In 2010, VBA received 1.2 million
claims. In 2011, VBA received another 1.3 million claims, including
claims from Veterans made eligible for benefits as a result of the
Secretary's decision to add three new presumptive conditions for
Veterans exposed to Agent Orange. In 2012, VBA received 1.08 million
claims. Over the last three years, the claims backlog has grown from
180 thousand to 600 thousand claims at the beginning of this month.
For decades, the VBA system has carried an inventory of pending
claims, and a backlog that was undefined and therefore confused with
inventory. In 2010, the Secretary of Veterans Affairs defined the
backlog as any disability claim pending over 125 days and increased
transparency by making our performance against our established goals
available on the internet. The backlog grows when the capacity does not
match demand.
In 2009, based on the Institute of Medicine's Veterans and Agent
Orange: Update 2008, and considering all available scientific evidence,
the Secretary made the decision to add three presumptive conditions
(Parkinson's disease, ischemic heart disease, and B-cell leukemias) for
Veterans who served in the Republic of Vietnam or were otherwise
exposed to the herbicide Agent Orange. Beginning in 2010, VBA
identified claims for these three conditions for special handling to
ensure compliance with the provisions in the Nehmer court decision that
requires VA to re-adjudicate claims for these conditions that were
previously denied. Nehmer claims for all living Veterans were completed
as of April 2012. VA identified the next of kin for the last remaining
Nehmer survivor claim and awarded benefits in October 2012. To date, VA
has received more than 278 thousand claims and awarded over $4.4 B in
retroactive benefits for the three new Agent Orange presumptive
conditions to more than 164 thousand Veterans and survivors.
Other factors that have resulted in the submission of more
disability claims, and hence contributed to the backlog, include VA
initiatives to increase access, and other conditions that increased
demand for VA to address unmet disability compensation needs:
Increased Access
1. Increased use of technology and social media by Veterans,
families, and survivors to self-inform about available benefits and
resources.
2. Improved access to benefits through the joint VA and DOD Pre-
Discharge programs.
3. Creation of additional presumptions of service connection
resulting in more claims for exposure-related disabilities.
4. Extensive and successful use of VA outreach programs to inform
more Veterans of their earned benefits, which can include compensation
claims.
Increased Demand
1. Ten years of war with increased survival rates for our wounded
2. Aging population of previous era Veterans such as Vietnam and
Korea, whose conditions are worsening
3. Impact of a difficult economy
4. Growth in the complexity of claims decisions as of result of the
increase in the average number of medical conditions for which each
claimant files.
The current composition of the inventory and backlog are claims
from Veterans of all eras--from Veterans of the current conflicts to
World War II Veterans who are just now filing a claim for the first
time. As of January 31, 2013, the largest cohorts of claims come from
our Vietnam-era Veterans who filed 448 thousand claims in FY 2012, and
currently make up 37 percent of the inventory and 38 percent of the
backlog. Veterans of Iraq and Afghanistan conflicts make up 20 percent
of the total inventory and 22 percent of the backlog. Gulf War Era
Veterans make up 23 percent of the total inventory and 22 percent of
the backlog. Veterans of the Korean War and World War II and all others
make up less than 10 percent of both total inventory and backlog. The
remainder of the inventory and backlog is from Peacetime Veterans only.
transformation
To meet the Secretary's goal of eliminating the backlog by 2015, we
have set out to transform VBA into a 21st century organization. VBA's
transformation is demanded by a new era, emerging technologies, and the
latest demographic realities. In the face of increasing complexity and
workloads, VBA must deliver first-rate and timely benefits and
services--and they must be delivered with greater efficiency. VBA is
aggressively pursuing its Transformation Plan, 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 with 98 percent accuracy in 2015. VBA is
retraining, reorganizing, streamlining business processes, and building
and implementing technology solutions based on the newly redesigned
processes in order to improve benefits delivery.
People
VBA's employees are the key to Transformation success, and over 52
percent of them are Veterans themselves. In order to have the best-
trained, most efficient and highly skilled workforce, VBA is changing
how its workforce is organized and trained to decide disability
compensation claims. Sixty-three percent of VBA's workforce has a
bachelors' degree or higher. Average length of service is 11 years, and
average age is 44. Fourteen percent are retirement eligible, and our
turnover rate is only seven percent annually.
Transformation Organizational Model
VBA's new standardized organizational model incorporates a case-
management approach to claims processing. VBA is reorganizing its
workforce into cross-functional teams that enable employee visibility
of the entire processing cycle of a Veteran's claim. These cross-
functional teams work together on one of three segmented lanes:
express, special operations, or core. Distinct processing lanes are
based on the complexity and priority of the claims and employees are
assigned to the lanes based on their experience and skill levels.
Claims that predictably can take less time flow through an express lane
(30 percent); those taking more time or requiring special handling will
flow through a special operations lane (10 percent); and the rest of
the claims flow through the core lane (60 percent). Lanes were
established based on the complexity and priority of the claims and
employees are assigned to the lanes based on their experience and skill
levels.
The Express Lane was developed to identify those claims with a
limited number of medical conditions (1-2 issues) and subject matter
which could be developed and rated more quickly, including fully
developed claims. The Special Operations Lane applies intense focus and
case management on specific categories of claims that require special
processing or training (e.g., homeless, terminally ill, military sexual
trauma, former prisoners of war, seriously injured, etc.). The Core
Lane includes claims with three more medical issues that do not involve
special populations of Veterans. Less complex claims move quickly
through the system in the express lane, and the quality of our
decisions improves by assigning more experienced and skilled employees
to the more complex claims in our special operations lane.
Initially planned for deployment throughout FY 2013, VBA
accelerated the implementation of the new organizational model by nine
months due to early indications of its positive impact on performance.
Given the magnitude of this change, each office transitions to the new
organizational model individually. Significant support and training
from VBA Headquarters have been critical in this stage. As of the end
of 2012, the new organizational model was fully operational at 51
regional offices, and three more have since implemented the new model.
The remaining two regional offices will implement the model by the end
of this month.
Challenge Training and Quality Review Teams (QRTs)
The productivity of the workforce and the accuracy of decisions are
being increased through new national training programs and standards.
VBA instituted Challenge training in 2011 and Quality Review Teams
(QRTs) in 2012 to improve employee training and accuracy while
decreasing rework time. Challenge training is focused on overall skills
and readiness of the workforce, and QRTs focus on improving performance
on the most common sources of error in the claims processing cycle;
data on VBA's largest sources of error are captured and analyzed by its
National Accuracy Team. Today, for example, QRTs are focused on the
process by which proper physical examinations are ordered; incorrect or
insufficient exams previously accounted for 30 percent of VBA's error
rate. As a result of this focus, VBA has seen a 23 percent improvement
in this area.
The 1,900 new employees who have received Challenge training decide
150 percent more claims per day than predecessor cohorts, with a 30
percent increase in accuracy, (i.e. these new employees decide 150
percent more claims per day than previous groups of employees at a
similar stage in their development). This is a marked improvement in
performance, and is being scaled across the entire enterprise as new
employees are hired. Five Challenge training sessions are planned for
FY 2013. As of March 1, 2012, VBA initiated a new Challenge course
focused on improving the low performing regional offices. At the first
office quality increased by eight percentage points in three months and
the number of claims processed per month increased by more than 27
percent. Similar results are being seen by the second RO that completed
SET in January 2013.
VBA tracks the impact of these initiatives on accuracy through a
three-month rolling average accuracy metric that is reported in ASPIRE
and can be seen online by anyone inside or outside VA. FY 2012 data
demonstrated a three percent increase in national accuracy standards--
from 83 percent to 86 percent. The accuracy outcome objectives for the
next three years are: 90 percent in FY 2013, 93 percent in FY 2014, and
98 percent in FY 2015.
The current 12-month measure of the accuracy of our disability
rating decisions increased to over 86 percent--and further improved to
over 87 percent when looking at just the last three months. It is
important to recognize that under the existing quality review system,
any one error on the claim, no matter how many medical conditions must
be developed and evaluated, makes the entire claim in error--the claim
is therefore counted as either 100 percent accurate or 100 percent in
error, with no credit for anything in between. Issues are defined as
individually evaluated medical conditions. A claim can, and often does,
consist of many issues. Each issue represents a series of completed
tasks, such as development, research, adjudication, and decision, that
could result in a benefit adjustment for a Veteran, family member, or
survivor. Given that the average number of claimed issues for our
recently separated Servicemembers is now in the 12 to 16 range, we do
not believe the current all-or-nothing measure reflects the actual
level of decision accuracy achieved. When we measure the same claims
based on assessments of the individual medical conditions rated
(``issue-based accuracy''), the accuracy of our decisions is over 95
percent. This issue-based accuracy approach also affords VBA the
opportunity to target with precision those medical issues where we make
the most errors--and includes employee level medical issue accuracy.
Process Initiatives
Through process-improvement initiatives, VBA is rapidly developing
and testing streamlined business processes, focusing on eliminating
repetition and rework. VBA established a ``Design Team'' concept to
support business-process transformation. Using design teams, VBA
conducts rapid development and testing of process changes and automated
processing tools in the workplace. This design team process
demonstrates through pilot initiatives that changes are actionable and
effective before they are implemented nationwide.
Since 2009, VBA has actively solicited innovative ideas for process
improvement from Veterans, employees, and industry stakeholders through
a variety of structured mechanisms. Literally thousands of ideas were
received and culled down to those with the largest potential to attack
the backlog. For example, automated Disability Benefits Questionnaires
(DBQs) (discussed below)--arguably one of the most highly leveraged
changes--came from one of the VBA employee idea competitions.
Additionally, VBA has also conducted Lean Six Sigma and Kaizen events
on these selected targets of opportunity, all focused on five major
areas of focus: wait time, rework, productivity, digital intake, and
variance.
Simplified Notification Letters
The Simplified Notification Letter initiative has reduced
keystrokes and automated production language in preparation of the
Veteran's decision letter, thus improving rating decision productivity
and accuracy. VBA implemented this initiative nationally on March 1,
2012, and it decreased the number of claims ``waiting'' for a rating
decision by 55 percent. This translated into over 10,000 more rating
decisions in the month of December (94,292) than in the month of March
(84,115). The SNL process does not change the way we consider and
decide claims, but rather changes the primary focus of what appears in
the final decision document. We do this in part through the use of an
internal coding system designed to streamline processing and
communicate standardized reasons and bases from the decisionmakers to
the award processors (who generate the final notice letters, authorize
the monetary awards, and perform other ministerial functions). SNL
increased the number of auto-text selections available for raters to
use to explain decisions, thereby improving decision accuracy and
productivity.
Calculators and Evaluation Builder
VBA is building new decision-support tools to make our employees
more efficient and their decisions more consistent and accurate. We
already have developed rules-based calculators for disability claims
decisionmakers to provide suggested evaluations. For example, the
hearing loss calculator automates decisions using objective audiology
data and rules-based functionality to provide the decisionmaker with a
suggested decision.
The Evaluation Builder is essentially an interactive disability
rating schedule. The VBA decisionmaker uses a series of check boxes
that are associated with the Veteran's symptoms. The Evaluation Builder
determines the proper diagnostic code out of over 800 codes as well as
the level of compensation based on the Veteran's symptoms. The Veteran
receives an accurate rating decision every time the Evaluation Builder
is used. This saves employees time that would have been spent looking
up the rating schedule in a paper format. To date, five of the 15 body
systems in the VA Schedule of Rating Disabilities have been embedded
into VBMS, and the Evaluation Builder will have complete functionality
(all body systems) in VBMS by November of this year.
Disability Benefits Questionnaires (DBQs)
DBQs replace traditional VA examination reports and are designed to
capture all the needed medical information relevant to a specific
condition at once and up front so that claims can be developed and
processed in a more timely and accurate manner, with the end result
being faster service for Veterans. DBQs change the way medical evidence
is collected, giving Veterans the option of having their private
physician complete a DBQ that provides the medical information needed
to rate their claims--minimizing the need for a VA exam which adds
additional time to the claim development process. Information in the
DBQs maps to the VA Schedule for Rating Disabilities, and provides all
of the necessary information to decide a disability claim. Fully and
properly completed DBQs, whether from private providers or within the
internal VA examination processes, have the potential to reduce rework,
the largest category being exams with insufficient information.
In FY 2013 to date, nearly 600,000 DBQs have been completed by VHA
examiners. Since their introduction, VBA has received over 12,000 DBQs
outside of the traditional examination process. Using DBQs, VA
examination and examination-request accuracy improved to 92 percent
nationwide, compared to the legacy quality program, which showed
accuracy of 84 percent when last conducted in 2009. Seventy-one of
eighty-one individual DBQs, unique forms designed to document specific
health conditions are available to private physicians. VBA is reaching
out to stakeholders, particularly Veterans Service Organizations
(VSOs), State and County partners, and private medical doctors to
request their support in encouraging Veterans to use DBQs for more
timely and accurate rating decisions. VA recently secured DOD
concurrence to pilot the use of DBQs within the Integrated Disability
Evaluation System (IDES) process. VBA's future goal is to turn DBQ
objective responses into data to drive a calculator-based business-
rules engine in VBMS to achieve automated decision support to improve
consistency and accuracy of decisions and reduce processing time per
case.
Acceptable Clinical Evidence (ACE)
ACE is a new approach that was implemented in October 2012. This
process allows clinicians to review existing medical evidence and
determine whether that evidence can be used to complete a DBQ without
requiring the Veteran to report for an in-person examination. For many
Veterans, this means they no longer need to travel and take time off
for an examination, which can be a significant burden requiring them to
leave work and interfering with their family life. Clinicians also have
the option to supplement medical evidence with telephone interviews
with the Veteran, or to conduct an in-person examination if determined
necessary. To date, VA has processed 1,931 claims using the ACE
initiative.
Compensation and Pension Records Interchange (CAPRI)
CAPRI software provides VBA employees with a standardized, user-
friendly method to access Veterans' medical records throughout the VA
healthcare system. In November 2011, VBA stopped printing Veterans
Health Administration (VHA) treatment records, saving the effort and
dollars associated with printing, filing, and storing these records.
Under a partnership with VHA, the CAPRI program has recently been
enhanced to send records electronically to VBA's paperless repository
with just a few mouse clicks, further simplifying the process and
reducing the task time. As of March 1, 2013, 45 sites within VBA have
received this upgrade, with deployment for remaining sites scheduled to
begin on March 31, 2013. To date, VBA has avoided printing more than 90
million pages of digital medical records (currently averaging six
million/month) and spending over 422,000 man hours printing and
filing--saving time and resources that are redirected toward backlog
elimination. Because of these CAPRI enhancements, VBA estimates a $2.5
million cost avoidance annually on paper and toner that is also being
used to support staffing resources to help eliminate the backlog.
Fully Developed Claims (FDCs)
FDCs are critical to achieving VBA's goals. A fully developed claim
is one that includes all DOD service medical and personnel records,
including entrance and exit exams, applicable DBQs, any private medical
records, and a fully completed claim form. An FDC is critical to
reducing ``wait time'' and ``rework.'' Today, VBA receives only 4.8
percent of claims in fully developed form, which equates to 5,600
claims this fiscal year through February. When a qualified FDC is
received, VBA is able to discharge its evidence-gathering
responsibilities under the Veterans Claims Assistance Act much more
efficiently than in traditional claims. This evidence-gathering period
is a major portion of the current 262-day process. Today, VBA completes
these FDCs in 117 days. VBA's target for FY 2013 is to increase these
FDCs to 20 percent--meaning VBA will have the ability, if this goal is
reached, to decide 153,000 additional claims in 117 days.
Internal Revenue Service and Social Security Administration
Data Sharing
VA developed an expanded data-sharing initiative with the Internal
Revenue Service (IRS) and Social Security Administration (SSA) for up-
front verification of income for pension applicants and to streamline
income verification matches. This initiative enabled VBA to eliminate
an annual reporting surge of 150,000 work items and redirect
significant FTE to address the backlog of Dependency and Indemnity
Compensation (DIC) claims from Survivors.
Technology
Key to VBA's transformation is ending the reliance on the outmoded
paper-intensive processes. VBA is deploying technology solutions that
improve access, drive automation, reduce variance, and enable faster
and more efficient operations. VBA's digital, paperless environment
also enables greater exchange of information and increased transparency
to Veterans, the workforce, and stakeholders. Our technology
initiatives are designed to transform claims processing from the time
the Servicemember first enrolls in the joint VA and DOD eBenefits
system and submits an on-line application to the issuance of the claims
decision and receipt of compensation payments.
Veterans Benefits Management System (VBMS)
VBMS is a web-based, electronic claims processing solution
complemented by improved business processes. It will assist in
eliminating the existing claims backlog and serve as the technology
platform for quicker, more accurate claims processing.
National deployment of VBMS began in 2012, with 18 regional offices
operational as of the end of the calendar year. Deployment to the 38
remaining stations is ongoing. We estimate that once VBMS is fully
developed in 2015, integrated, and implemented, it will help improve
VBA's production by at least 20 percent (in each of fiscal years 2014
and 2015) and accuracy by at least eight percent.
The evolution of VBMS is occurring across four distinct phases, or
generations of development. Generation One of VBMS began in 2010 with
the conceptualization, piloting, development, and deployment of
baseline system functionality with improved quality (required actions
and automation) and efficiency (no paper). Generation One of VBMS
concluded with the successful implementation of Release 4.1 in
January 2013. This generation culminated in a foundational web-based,
electronic claims processing solution featuring:
Integrated claims establishment, development, and rating
capabilities;
Basic baseline automation via features such as automated
letter generation and data population; and
Basic workflow and workload management capabilities.
With the deployment of the latest system release, integration with
VONAPP Direct Connect (VDC) and the Stakeholder Enterprise Portal (SEP)
further enhanced the system's capabilities by improving data exchange
and status transparency with applicants, VSO partners, State and County
Veterans agencies, and other stakeholders.
At the end of February, 2013, 1,084 paper-based and electronic
claims have been rated using VBMS and 77,393 electronic folders
(eFolders) have been created in VBMS. Claims are being completed in
VBMS in an average of 92.4 days. There are over 12,000 users of VBMS to
include VHA and VSOs. VBMS has also successfully received over 2.5
million documents and over 32.2 million images.
As we move into Generation Two of VBMS, the focus is on building
additional system capabilities while leveraging simple automation
features and deploying the system to all remaining sites. Upcoming
system releases include planned improvements to correspondence and work
queue tools, additional rating calculator functionality, and more
extensive data exchange and system integration capabilities.
National deployment of VBMS to all 56 regional offices is on track
for completion in 2013. Each VBMS site deployment is supported by
organizational change management practices (including training) to
ensure business lines are able to adapt to and adopt the new
technologies and solutions.
Generation Three of VBMS in 2014 will focus on continuing to
improve electronic claims processing by providing increased system
functionality and more complex automation capabilities for all VBMS
end-users. VBMS enhancements will reduce dependency on legacy systems
for claims establishment, development, and rating. VBMS will have the
capability to accept electronic Veterans' Service Treatment Records
(STRs) and Personnel Records from DOD in support of the VOW to Hire
Heroes legislation. Additionally, VBMS end-users (to include VA Medical
Center personnel and VSOs) will be able to leverage enhanced system
functionality to perform their work more efficiently and accurately.
Development of functionality will provide end-users with the ability to
process claims electronically from receipt to payment. The addition of
functionality throughout 2014 and stabilization of system capabilities,
in conjunction with business process improvements, will increase
production and quality of claim decisions. This period of stability
will also allow VA an additional opportunity to assess and validate the
effectiveness of the model as a whole and implement improvements as
needed.
Generation Four of VBMS in 2015 will capitalize on efficiencies and
quality improvements gained during the year of stabilization. These
enhancements will allow end-users to focus on more difficult claims by
reducing the time required to process less complex claims. This period
will also allow VA to identify additional automation and process
improvement opportunities, enabling VA to meet the Secretary's goal of
processing all claims within 125 days at 98 percent accuracy.
When a claim is granted in VBMS, a payment is processed, and
notification is sent to the Veteran through eBenefits and stakeholders
through Stakeholder Enterprise Portal (SEP). This notification
completes the full lifecycle of paperless claims processing, from
portal to payment.
Veterans Relationship Management (VRM)
VRM engages, empowers, and serves Veterans and other claimants with
seamless, secure, and on-demand access to benefits and service
information. Veterans now have access to benefits information from
multiple channels--on the phone, on line, or through our shared DOD/VA
portal called eBenefits. VRM provides multiple self-service options for
Veterans and other stakeholders.
eBenefits
eBenefits--a joint VA/DOD client-services portal for life-long
engagement with Servicemembers, Veterans, and their families--is a key
component of VRM. eBenefits currently provides users with over 45 self-
service options and greater access to benefits and health information
at the time and method of their choosing. Through the eBenefits portal,
users can now check the status of claims or appeals, review VA payment
history, obtain military documents, and perform numerous other benefit
actions. Veterans can also view their scheduled VA medical
appointments, file benefits claims online in a Turbo Claim-like
approach, and upload supporting claims information that feeds our
paperless claims process.
There are currently over 2.5 million eBenefits users. Through self-
service, eBenefits users have generated over 228,000 requests for
official military personnel documents, 198,000 requests for VA
Guaranteed home loan certificates of eligibility, 16.5 million claim
status requests, and over 1.7 million self-service letters. Additional
functionality and features will continue to be added to the site in the
future, and VA will use milestones and life events to proactively
notify Veterans about benefits they may be eligible to receive.
VDC (Veterans Online Application, Direct Connect)
VDC incorporates a complete redesign of the legacy VONAPP
application system, leveraging the eBenefits portal. Claims filed
through eBenefits use VDC to load information and data directly into
the new VBMS application for paperless processing. Veterans can now
file both original and supplemental compensation claims through VDC.
Since the expanded version of VDC deployed in October 2012, over 1,500
claims have been received.
Stakeholder Enterprise Portal (SEP)
SEP is a secure web-based access point for VA's business partners.
This portal provides the ability for VSOs and other external VA
business partners to represent Veterans quickly, efficiently, and
electronically. Because SEP is a new release, specific results are not
yet available.
VCIP
VBA recently established the Veterans Claims Intake Program (VCIP).
This program is tasked with streamlining processes for receiving
records and data into VBMS and other VBA systems. Scanning operations
and the transfer of Veteran data into VBMS are primary intake
capabilities that are managed by VCIP. As VBMS is deployed to
additional regional offices, document scanning becomes increasingly
important as the main mechanism for transitioning from paper-based
claim folders to the new electronic environment. The VCIP contractors
began scanning on September 10, 2012. The ramp-up volume mirrored the
VBMS deployment plan for the 18 regional offices on VBMS as of the end
of CY 2012. By the end of December 2012, the VBA contractors were
providing five million images per month. By the end of CY 2013, the
contractors will be providing up to 70 million images per month as they
convert paper records to electronic format.
Strategic Planning and Governance
VBA's Office of Strategic Planning (OSP) coordinates VBA's
strategic planning and the governance process for developing new
transformation initiatives. The focus of this office is on creating a
culture centered on advocacy for Veterans, reengineering business
processes, integrating new technologies, and redesigning our
organization and infrastructure. New ideas are approved through a
governance process that includes senior VBA leadership who serve on the
VBA Transformation Governance Board responsible for evaluating and
making recommendations for my approval. This ensures VBA's focus is on
implementing initiatives that will achieve the greatest gains, without
degrading current performance.
The VBA Implementation Center/Operations Center (VBA-IC/OC) is a
division of the Office of Field Operations. The VBA-IC/OC prepares,
executes and assesses the implementation of transformation initiatives,
managing the project lifecycle through a comprehensive Work Breakdown
Structure (WBS) and Critical Path methodology. The VBA-IC/OC also
serves as the liaison between the field and Headquarters throughout the
implementation process, providing channels of communication that are
essential to successful implementation. The VBA-IC/OC monitors and
supports regional offices through an end-user hotline, which is open
during normal business hours. In addition, I hold weekly three-hour
``pulse-check'' calls with the employees of all regional offices
adopting new initiatives to ensure all issues are raised and properly
assessed. The VBA-IC/OC gathers and reports implementation performance
metrics to provide support for VA leadership decisionmaking.
stat reviews
VBA's Stat Reviews are a performance technique and tool using
statistical data (Stat) and visual displays of that data to monitor
progress and improve performance. This process involves in-depth
performance metric reviews with VBA's Office of Field Operations and
other members of VBA leadership to analyze and manage performance more
effectively.
VBA's Stat Reviews are based on highly successful performance
management programs conducted governmentwide. I sit at the table with
regional office directors in the day-long meeting to discuss challenges
and successes, using performance measures for accountability. This
allows VBA leadership to more easily identify what improvements are
needed to produce desired performance results. Stat Reviews also help
VBA leadership understand what is or is not working, while motivating
regional office managers and employees to focus their energy and
creativity on achieving specific results.
The Stat Review process encourages:
1. Focus on accountability to achieve workload performance metrics.
2. Information-sharing of best practices across VBA regional
offices and VBA leadership.
As a monthly event, the Stat Reviews identify patterns occurring at
various regional offices, and every regional office participates either
in person or by teleconference. These reviews help to ensure we have
alignment across ROs on Transformation and that best practices and
lessons learned are shared quickly across leadership teams.
partnerships
Support from our partners and stakeholders is critical to better
serving our Veterans, Servicemembers, and their families. Our
transformation changes our interactions with employees, other Federal
agencies, VSOs, and State and County service officers. VBA has worked
to create partnerships through pilot projects with these organizations
to improve benefits delivery. I continue to meet monthly with the
Executive Directors of six national VSOs and have established quarterly
stakeholder meetings with a larger group of VSOs directly affected by
new processes and initiatives. VBA engages these organizations for
their feedback and input at the beginning stages of the various
initiatives.
While stakeholder engagement is important to nearly all of VBA's
transformation initiatives, support from VSOs and State and County
service officers will be especially critical to the success of four
initiatives: eBenefits, SEP, FDC, and DBQs. VBA has involved
stakeholders in development, user-access testing, and training for
these initiatives, and we are now partnering to increase Veterans'
awareness and utilization in order to expedite the claims process.
VBA is exploring incentives for its VSO and State and County
partners to increase FDC submission because of the game-changing impact
this can have on claims-decision timeliness and eliminating the
disability claims backlog. A 20-percent FDC submission level is
estimated to increase annual production by 70,000 claims and reduce
overall average days to complete by 18 days.
VBA has an agreement with DOD to provide 100-percent-complete
service treatment and personnel records in an electronic, searchable
format for the 300,000 annually departing Active Duty, National Guard
and Reserve Servicemembers. This will further increase the number of
FDCs. When implemented, this action has potential to cut as much as 60-
90 days from the ``awaiting evidence'' portion of claims processing,
and reduce the time needed to make a claim ``ready for decision'' from
133 days currently to 73 days for departing Servicemembers.
VBA will continue to pursue various partnerships with Federal
agencies, VSOs, as well as profit and non-profit organizations to
expand and enhance our transformation initiatives.
conclusion
VA is in an era of unprecedented production and unprecedented
demand, and our Transformation Plan is critical to achieving our goals
for improving the delivery of benefits to our Veterans, their families,
and Survivors. We will continue to vigorously pursue our people,
process and technology-centered improvements designed to eliminate the
claims backlog and achieve our goal in 2015 of processing all claims
within 125 days with 98 percent accuracy.
Mr. Chairman, this concludes my statement. I would be pleased to
answer any questions you or other Members of the Committee may have.
______
______
Response to Posthearing Questions Submitted by Hon. Bernard Sanders
to U.S. Department of Veterans Affairs
Question 1. General Hickey's written testimony stated:
``It is important to recognize that under the existing quality
review system, any one error on the claim, no matter how many
medical conditions must be developed and evaluated, makes the
entire claim in error--the claim is therefore counted as either
100 percent accurate or 100 percent in error, with no credit
for anything in between. Issues are defined as individually
evaluated medical conditions. A claim can, and often does,
consist of many issues. Each issue represents a series of
completed tasks, such as development, research, adjudication,
and decision, that could result in a benefit adjustment for a
Veteran, family member, or survivor. Given that the average
number of claimed issues for our recently separated
Servicemembers is now in the 12 to 16 range, we do not believe
the current all-or-nothing measure reflects the actual level of
decision accuracy achieved. When we measure the same claims
based on assessments of the individual medical conditions rated
(``issue-based accuracy''), the accuracy of our decisions is
over 95 percent. This issue-based accuracy approach also
affords VBA the opportunity to target with precision those
medical issues where we make the most errors--and includes
employee level medical issue accuracy.''
This is a significant departure from the current method by which VA
measures accuracy. Will VA also continue to measure accuracy by claim
in order to allow stakeholders to evaluate quality in multiple ways
including using comparable historical accuracy measurements?
Response. VBA is currently tracking these measures in parallel. We
continue to track the accuracy of each claim being reviewed under our
existing quality review system as well as under the issued-based
accuracy review approach.
Question 2. During the hearing VA testified that VBA now receives
information on a weekly basis from the Social Security Administration
and the Internal Revenue Service. Are all regional offices currently
receiving Social Security medical evidence on a weekly basis? Is this
evidence being received in an electronic format which can be
incorporated into VBMS? How many files have been received from the
Social Security Administration at each regional office under this
procedure?
Response. Under the authority provided by 26 U.S.C. Sec. 6103(l)(7)
and 38 U.S.C. Sec. 5317, VA obtains from the Social Security
Administration (SSA) and the Internal Revenue Service (IRS) income
information for certain VA beneficiaries. VA uses this information in
its Income Verification Match (IVM) program to verify entitlement to,
among other things, VA's needs-based pension benefits. As discussed in
the hearing, VA is working with IRS and SSA to expand the IVM program
and develop a process in which VA exchanges records on a weekly basis
with IRS and SSA to determine eligibility for pension before VA makes
payments.
In addition, VBA and SSA officials meet weekly to develop
strategies for more quickly obtaining SSA medical records needed for
VBA claims. As a result, SSA is now directly uploading electronic
medical records into VA's systems at four regional offices. Working
collaboratively, SSA and VA have standardized the file size and format
and also implemented procedures to exclude VA medical records from the
SSA records sent. These improvements have reduced duplication and
streamlined the transmittal and review process. Early results, based on
two months of testing at these four stations, reflect that VA is
receiving SSA records in an average of nine days, which is an
improvement compared to the average of fifteen days using the current
manual process (obtaining the information on a CD) and sixty days using
the old paper process. VA plans to begin a phased deployment, starting
with a regional office that is using VBMS, to finalize procedures
before implementing nationwide.
Question 3. Please explain how external users of VBMS, including
VSOs and contractors who conduct disability exams, connect to and
utilize VBMS. Have external users reported issues of network latency or
reliability of connection for external VBMS users? If there have been
reported issues, describe actions taken to address these issues and
whether the issues have been resolved?
Response. All VBMS users access the application through the VA
network to ensure security of Veterans claim information and data. If
users are located at a VA facility, VBMS is accessed through the local
VA network. If users are not located at a VA facility, they must first
access the VA network using approved VA software to create a Virtual
Private Network connection.
VBA continues to address and resolve all reported instances of
latency and issues with access. For example, in response to VSOs
reporting an issue with the total number of claims loaded into the VSO
work queue, VBA upgraded VBMS to increase the number of claims visible
by VSOs to 1,000 in February 2013. In addition, contract examiners
using a central location to access VBMS and distribute claims
information to contract examiners throughout the country, reported an
issue with viewing large files. Collaboration with the central location
identified the need to issue government furnished equipment to ensure
access and visibility at the central location. In addition, users not
located at VA facilities may experience slow response times (latency)
due to speed of the user's connection as well as other internet-related
performance and connectivity issues outside the control of VA. VBA is
committed to ensuring all users requiring access to VBMS have the
necessary access and continuing collaboration with our partners.
Question 4. Testimony indicated VBA's target for FY 2013 is to
increase use of fully developed claims to 20 percent. Based upon Fast
Letter 12-25, many claims are excluded from consideration as fully
developed claims. For example, if a veteran has another claim pending
or has an appeal pending and the claims folder is not located at the
home RO, VA will not accept a fully developed claim on another issue.
a. Please provide information concerning the number of claims filed
as fully developed claims which are rejected because another claim is
pending or on appeal?
Response. Fiscal year to date, 17 percent of claims filed as fully
developed have been excluded for various reasons.
b. What is VA's rationale for refusing to process fully developed
claims in these circumstances?
Response. VA designed the Fully Developed Claims (FDC) program to
provide claimants the fastest possible decision on their claims. When a
subsequent claim is received, VA must complete new development actions
often required by the subsequent claim, which may impact the rating
decision and delay completion of these claims. At the request of
stakeholders, VA made an exception to this rule if the pending claim is
an appeal, and the claim folder is located at the regional office of
jurisdiction rather than at the Board of Veterans' Appeals (BVA). This
specific exception maintains the integrity of the FDC program and its
promise of expeditious processing as it does not impact the timely
completion of the FDCs.
______
Response to Posthearing Questions Submitted by Hon. Richard Burr to
U.S. Department of Veterans Affairs
Question 1. At the hearing, General Hickey provided this testimony:
``There are two major things that we need in order to decide
those claims that are in inventory and in backlog. Three out of
five times that we have an old claim it's because of this
issue. We need data from [the Department of Defense] in terms
of the complete medical history of that member when they leave
service in order for us to decide a claim. We also need their
complete personnel records in order to know what their
character of service is. Without those, we must ask. When we
ask, we have in legislation today a 60-day wait period before
we may ask again. So there is built into our process part of
that problem.''
A. Please identify the specific legislative provision that is
referenced above and explain why VA interprets it as requiring a 60-day
wait period.
Response. General Hickey was referring to VA's duty under the
Veterans Claims Assistance Act, 38 U.S.C. 5103A(b)(3), requiring that
VA continue efforts to obtain Federal records ``unless it is reasonably
certain that such records do not exist or that further efforts to
obtain those records would be futile.'' VBA has implemented this
statutory requirement by providing guidance in its procedures manual,
directing that VA claims processors are to make an initial request for
Federal records, wait for 60 days for a response, to be followed by
another request for the records, with a subsequent follow-up waiting
period of 30 days. This ``futility standard'' for obtaining Federal
records often adds considerable time to the claims process. The
corresponding duty for non-Federal records requests only requires
``reasonable efforts'' to obtain them rather than ``exhaustive
efforts.''
Neither statute nor regulation specifies a required wait time for
response from a Federal agency. VA has discretion to determine what
efforts and time limits are necessary to meet the statutory
requirements for seeking records of another agency. However, the
statute requires VA to continue to seek Federal records until it is
reasonably certain that such records do not exist or that further
efforts to obtain them would be futile. Such legislation was enacted to
better define the standards for VA requests for private (but not
Federal) records in August 2012, as section 505 of Public Law 112-154.
B. For the record, please provide a copy of any relevant VA
policies (including regulations, Manual provisions, Fast Letters,
Training Letters, or other internal VA guidance) regarding the
procedures to be followed in obtaining evidence from the Department of
Defense or Social Security Administration.
Response. Please see the attached documents, which explain the
policies and procedures surrounding VBA interaction with the Department
of Defense and Social Security Administration in obtaining evidence
required to process Veterans' claims. Attachments include:
User guides for
- the Defense Personnel Image Retrieval System (DPRIS), and
- the Personnel Information Exchange System (PIES)
A PowerPoint slide show that introduces DPRIS and its
functionality
Compensation Service Fast Letter (FL) 11-01, MILPAY
Application for VA Readjudication of Nehmer Claims
Compensation Service Training Letter (TL) 09-02, Uploading
DPRIS-Imaged DD Forms 214 and 215 into Virtual VA
Two documents containing text from 38 Code of Federal
Regulations (CFR)
- 3.159, Department of Veterans Affairs Assistance in
Developing Claims, and
- 3.201, Exchange of Evidence; Social Security and Department
of Veterans Affairs
Documents containing text from M21-1MR
- Part III, Subpart iii, Chapter 2, Developing for Service
Records
- Part III, Subpart iii, Chapter 3, Information Requests to
and From the Social Security Administration (SSA), and
- Part IV, Subpart ii, Chapter 1, Development.
C. Please provide any relevant statistics on the number of claims
that are considered backlogged solely because VA has not received
relevant evidence from the Department of Defense or Social Security
Administration.
Response. This response requires programming for a data pull and
will be provided at a later date.
______
Response to Posthearing Questions Submitted by Hon. Mark Begich to
U.S. Department of Veterans Affairs
Question 1. What type of time motion study is being conducted to
study VBMS' efficiencies/inefficiencies? Will this study be used to
develop performance standards for employees? Is the study group
soliciting the input of the employees doing the work on the front
lines? (Senator, a few years ago IBM did a study of this at the
direction of the Committee and determined that an evidence based time
motion study was a good idea!)
Response. VBA is currently conducting a time motion study to
enhance its capacity management and estimating capabilities. VBA is
observing employees at six regional offices and recording the time
required to execute key claims processing activities. VBA is also
conducting analysis to determine the frequency with which these
activities are executed to fully adjudicate disability compensation and
pension claims. Together, these analyses provide a basis for
determining the manpower required to complete specific claims. Although
the study is focused on the claims process in its entirety, observers
will be noting when activities are implemented using VBMS, providing a
basis for assessing how the system is impacting process efficiency. The
data derived from this study will contribute to an evaluation of the
entire claims process and assist in determining what improvement can be
made in accomplishing the elements leading to claims completion. The
results of the study will not be used to develop new performance
standards.
Question 2. Are you aware that in certain facilities, 49% of
employees are not able to achieve the new performance standards?
Response. Performance standards are used to make a basic
determination that an employee is meeting his or her job requirements.
Employees receive on-going feedback on the elements included in their
performance standards. We recognize the importance of assessing the
impact of our transformational initiatives on employees' job
requirements and appropriately adjusting performance standards.
We recently revised our performance standards to account for
segmented lanes. On December 1, 2012, the regional offices implemented
new performance standards. We are still within a 90-day period allowed
for Veterans Service Representatives (VSRs) and Rating VSRs (RVSRs) to
become comfortable with the new standards. VBA established a new team
to work in conjunction with our labor union partner, the American
Federation of Government Employees (AFGE) to continue to develop
standards that will better serve Veterans and our employees as we move
into an electronic environment.
Question 3. What type of training will VA be introducing to update
employees on VBMS?
Response. VBMS is using a combination of web-based training (WBT)
and ``train-the-trainer'' concepts to ensure all VBMS users receive
system training and are prepared to use VBMS.
Robust WBT focuses on application training in which users learn how
to operate the new system and utilize the latest functionality. This
system training includes curricula tailored to job functions and
support resources to serve as quick reference guides.
The ``train-the-trainer'' component focuses on ensuring resources
are available to support users at regional offices. These local points
of contact, called Superusers, provide local training and prepare users
to successfully adopt VBMS. Superusers receive distance learning
training in addition to WBT and ongoing support sessions. Superusers
deliver information from their training to employees at their
respective regional offices. For example, prior to the release of new
system functionality, VBMS Superusers receive Delta training, which is
conducted virtually using Live-Meeting, on new functionality related to
major system releases. After attending Delta training, Superusers
facilitate Delta training to users at their Regional Office. Delta
training materials and instructions are made readily available to the
Superusers.
Question 4. Is VA soliciting input from employees on VBMS? What is
the mechanism for employees to discuss problems with the new system
with management?
Response. VA is utilizing a user-in-the-middle approach to solicit
system requirements for the development and enhancement of VBMS. Field
subject matter experts (SMEs) from across the country participate in
requirements gathering sessions with system developers every three
weeks in Charleston, South Carolina and in the Washington, DC
metropolitan area. SMEs provide input and are able to see their input
during pre-implementation review sessions.
Regional offices where VBMS is fully implemented participate in a
biweekly end-user experience conference call with the VBA Operations
Center to discuss issues and provide feedback on VBMS. Regional offices
may also exercise two additional options to provide feedback: the VBMS
Issue Tracker and a dedicated telephone hotline.
The VBMS Issue Tracker is for non-sensitive and/or non-
urgent issues requiring guidance and/or clarification.
The telephone hotline is for sensitive and/or urgent
issues where production is impacted. Stations may call into the hotline
and at that point, support is provided from a number of resources until
the issue is resolved.
Additionally, end-users at regional offices where VBMS is fully-
implemented participate in a weekly call with the Under Secretary for
Benefits to discuss both positive impact of the system as well as
issues of concern. Issues that end-users express as critical or
necessary to perform their job are addressed on the call and when
possible, new requirements and/or fixes are worked into a software
patch or future release. VBMS streamlined the release methodology by
implementing a Continuous Release process. This process leverages agile
methodologies to implement system updates via a continuous and steady
product release schedule. Each software release includes new
functionality and prioritized defect fixes. For example, the latest
VBMS Release 4.2 resolved more than 300 defects in addition to adding
new correspondence, rating, and evidence management functionality. The
incremental delivery approach allows the software development team to
continuously and quickly respond to user needs and feedback as the
software product is built. As the system evolves, new functionality
will be delivered to the field and build upon the foundational
architecture available in the latest system release.
Question 5. Are the scanning contractors paid by the page? What
types of quality review is VBA conducting to assess the quality of the
contractor's work?
Response. Scanning contractors are paid by the image, which is
defined as one side of one paper page. For quality review, VBA
contracted for independent verification and validation with a service-
disabled, Veteran-owned small business to evaluate the scanning
contractors' digital images. Metrics include image quality (99 percent)
indexing accuracy (99 percent) and data extraction from completed VA
forms (95 percent).
Question 6. Are there any plans to hire service-connected disabled
veterans to work directly for VBA to carry out scanning functions? Have
you assessed the quality and security risks involved in using outside
contractors?
Response. VA's focus is claims processing. The business case
analysis supports a centralized scanning model, with image volumes that
necessitate contractor support. VA incorporated a preference for
Veteran-owned small businesses as an evaluation factor. One of the two
VBMS scanning contracts was awarded to a service-disabled, Veteran-
owned small business. VA requires both scanning contractors to
incorporate Veterans hiring into their staffing plans. Also, VA
facilitates direct communications between Vocational Rehabilitation and
Employment Service, Vet Center Veteran candidates, and scanning
contractors.
VA assessed the security and quality risks associated with outside
contractors for this work. Outside vendors must comply with all VA
security regulations and have site security better than or equal to VA
regional offices. VA is not currently staffed, equipped, or trained to
do large-scale imaging and image quality review. Outside vendors
contribute their organizational expertise in document conversion and
industry best practices in image quality reviews.
Question 7. Have you put in place any plans for VBA claims
processors who are unable to read low quality scans (with bent or
upside pages?)
Response. Yes, VBA has done the following to help claims processors
view scanned images:
During the second quarter of FY 2013, scanning contractors
implemented software that auto-rotates an image.
VBA implemented procedures for claims processors to
resolve incorrectly oriented VBMS images.
VBMS rotation-functionality enables claims processors to
orient an inverted page when this occasionally occurs.
For systemic incorrectly-oriented images, claims
processors notify the VBMS help desk or designated VBA staff to request
re-scanned or re-oriented images.
Some records, by virtue of their original condition, are in such
poor condition that a legible copy is unattainable. VBA provided the
scanning vendors with specific guidelines to identify these types of
documents. Specifically, if images within a document do not scan
clearly or are otherwise unclear, the scanning vendors are instructed
to label those items as the ``best copy'' available. This process
identifies documents that are creased, frayed, deteriorated, torn,
faded, stained, or otherwise damaged. For documents that are bent or
creased, the vendor utilizes specific document preparation techniques
to straighten the document for scanning.
Question 8. The next questions are about the VBMS system. There are
significant bottlenecks in the implementation of this cost saving
program.
a. Has the VA assigned a senior management team to investigate
these bottlenecks?
Response. Yes, the Under Secretary for Benefits (USB) tasked the
Principal Deputy USB to examine the bottlenecks, and in conjunction
with the Assistant Deputy Chief Information Officer for Program
Management, they worked to resolve these issues. With resolution of
these issues achieved, VBA has developed and is implementing a plan to
ensure nationwide VBMS deployment by the end of 2013.
b. What action plan has the VA developed to stem the bottlenecks
and significantly increase the document flow to the imaging facility?
Response. VA closely analyzes shipping rates and makes necessary
adjustments to meet contractual minimums at the imaging facilities. The
current configuration of the scanning contract identifies a 20 million
minimum monthly image volume for each vendor, or a 40 million monthly
cumulative image volume. Once the national deployment VBMS is completed
and a review of contractor performance for the initial term is
conducted, there is the capability and capacity to exceed these
minimums based on organizational needs and through coordination with
the scanning vendors. Normal shipping procedures are accomplished
within four days. Once materials are received, the vendors process and
upload the corresponding images within a five-day timeframe.
To ensure there is no disruption to claims processing, VBA has
implemented a phased deployment schedule to regional offices. A
critical component of this schedule requires offices to send claims to
the scanning vendors shortly in advance of the VBMS deployment date.
This ensures that claims are not pending in VBMS and are ready to work
as soon as the deployment activities are complete for the regional
office.
As VBMS is deployed to all stations, additional claims become
eligible for VBMS processing. This increases the pool of claims that
are eligible for imaging.
c. What is the timetable for achieving the maximum ship or transfer
rate of files to the scanning facility to achieve the desired results?
Response. The primary goal of the scanning contract is meeting the
digital image demand to support VBMS deployment schedule and claims
processing. The current scanning focus is on new or reopened VBMS
claims. Volumes shipped to the scanning contractors will satisfy
guaranteed minimum images, but will not achieve maximum ship rates.
Alternative plans to increase volume include special projects to back-
scan inactive claims.
______
Response to Posthearing Questions Submitted by Hon. Mazie Hirono to
U.S. Department of Veterans Affairs
Question 1. What specific legislation could Congress propose to
improve the VA's claims process, electronic transformation efforts and
goals for a seamless transition for servicemembers from DOD to VA?
Response. VA is in the process of submitting several legislative
proposals to enhance and modernize the disability claims process with
its fiscal year (FY) 2014 budget. In addition, VA is working diligently
to implement the Honoring America's Veterans and Caring for Camp
Lejeune Families Act of 2012, Public Law 112-154, which contains
provisions that will improve the claims and appeals processes.
Question 2. 2015 is Secretary Shinseki's stated target year for
eliminating the VA's backlog of compensation claims along with a
maximum waiting period 125 days for a decision. Based on this month's
claims processing performance rate, is VA on track to meet this goal?
Response. VBA's Transformation Plan is designed to eliminate the
claims backlog and achieve our goal of processing all claims within 125
days with 98 percent accuracy in 2015. Initially planned for deployment
throughout FY 2013, VBA accelerated the implementation of the new
organizational model by nine months due to early indications of its
positive impact on performance. National deployment of Generation One
of VBMS (our baseline system) began in 2012, with 18 regional offices
operational as of the end of the calendar year. Deployment to the
remaining stations is scheduled to be completed by the end of calendar
year 2013.
Generation One of VBMS, our foundational web-based electronic
claims processing system, is now in use at 25 regional offices and the
Appeals Management Center. We will complete the deployment of VBMS to
all regional offices by December 2013. We will also continue to enhance
the automated functionalities and build additional system capabilities
in three future generations of VBMS to be deployed over the next two
years. As we move into future generations of VBMS, our focus is on
leveraging more complex automation features and more extensive data
exchange and system integration capabilities so that our employees will
be able to process claims electronically from receipt to payment.
Question 3. As you noted in your testimony, you gave the profile of
the average Veteran Benefits Administration (VBA) employee and you
stated that they are key to its transformation success into a 21st
century organization. As their work specifically impacts veterans and
their families, what percentage of VBA employees are veterans
themselves?
Response. As of February 28, 2013, 52 percent of VBA employees are
Veterans.
Question 4. In its December 2012 report, GAO recommended that VBA
``seek improvements for partnering with relevant Federal and state
military officials to reduce the time it takes to gather military
service records from National Guard and Reserve sources.'' What has the
VA done to date in this regard?
Response. Since the GAO report, VBA has accomplished the following:
The Chief, National Guard Bureau (NGB) recently hosted the
Under Secretary for Benefits as a pivotal speaker during the National
Guard Senior Leadership Conference held on February 27, 2013.
Significant messages specifically addressed National Guard and Reserve
benefits and resources, elements of today's operating environment, and
collaborating in 2013 and beyond.
The Chief, NGB and the Under Secretary for Benefits agreed
to charter an NGB/VBA Collaboration Team to immediately leverage
efforts between both staffs to identify and prioritize key cooperative
actions. The Collaboration Team will examine ways to refine the process
of records retrieval and identify procedures to improve the claims
process.
VA is including separating full-time National Guard and
Reserve members (Titles 10 and 32) in its implementation of the VOW to
Hire Heroes Act of 2011.
The Under Secretary for Benefits instructed all VBA
regional office directors to contact their respective state Adjutant
Generals to further engage in their critical relationships and identify
and overcome any barriers to obtaining Servicemembers' personnel and
medical records.
VBA created a comprehensive web site specifically aimed at
informing National Guard and Reserve members on how to take advantage
of their VA benefits (http://www.benefits.va.gov/guardreserve/).
The VBA and DOD Disability Claims Reduction Task Force was
formed to help VBA partner with Federal and state officials to reduce
the time it takes to gather military service records from DOD,
including National Guard and Reserve records.
Question 5. My understanding is that VBMS, the electronic Veterans
Benefits Management System has already been deployed to at least 18 VBA
regional offices and will be fielded to all 56 regional offices by the
end of this year. Secretary Shinseki has stated that ``the faster we
field VBMS, the more time we will have to eliminate the backlog.'' What
is the status of its implementation at the Honolulu Regional Office and
by how much do you estimate it will improve the processing rate at that
office?
Response. Deployment of VBMS to the Honolulu Regional Office is
scheduled for May 24, 2013. We anticipate that VBMS will provide a 15-
20 percent increase in station production in each of fiscal years 2014
and 2015 as we continue to add enhanced functionalities and automated
tools to VBMS.
Question 6. As you noted in your testimony you mention that the VBA
has taken suggestions from veterans and veterans organization on how to
improve the system? Aside from those the VA has already implemented,
what other proposals are being considered?
Response. Employees, Veterans, Veterans Service Organizations, and
other stakeholders are encouraged to provide transformation ideas to
VBA's Office of Strategic Planning for consideration and evaluation in
accordance with our governance review process. This process includes a
determination as to whether the idea has merit, should be considered
for a pilot, warrants a design team evaluation, and satisfies cost
benefit considerations. Additional input is received from Veterans
Service Organizations during the development and testing of
initiatives. Numerous ideas are in different phases of this evaluation
process, including, but not limited to, the following:
Appeals Design Team: Identifying recommendations to
improve the timeliness, consistency, and accuracy of the appeal
process.
Private Medical Records: Expediting claims development by
utilizing a contractor to aggressively pursue private medical records.
The goal is to support our duty to assist Veterans by obtaining and
electronically incorporating records into the Veterans claims for more
timely adjudication.
Click 2 Benefits: Establishing kiosks in VA medical
facilities that are geographically separated from VA regional offices.
These kiosks would support Veterans speaking with a VSR, who could be
hundreds of miles away. It facilitates better communication when a
Veteran needs assistance and cannot physically go to a regional office.
Issue-Based Quality Review: Evaluating rating quality
based on each individual medical issue addressed within the rating
decision. This approach more accurately reflects the actual quality of
rating decisions. It also provides a greater level of specificity about
errors being made that can be corrected by incorporating the lessons
learned into National Challenge Training.
Rules-Based Processing: Automatically processing incoming
dependency change requests utilizing a rules-based processing system.
Successfully developing automated rules-based processing will relieve a
significant portion of the workforce from handling these requests and
allow them to work on more disability claims.
Telework: Developing and implementing a telework pilot
program to meet agency telework requirements, while improving employee
productivity and allowing office space to be more effectively shared
and utilized.
Question 7. Has the VA looked into hiring temporary claims
processors, preferably veterans, similar to how the State Department
has done with limited non-career appointments for visa processing? Does
VA currently have the authority to do this?
Response. Because of the extensive training required to process
disability claims, VA prefers to use the funds made available by
Congress to hire and train permanent employees.
Question 8. You mentioned in your testimony that VA has partnered
with the IRS and the Social Security Administration to share data for
up-front verification of income for pension applicants and other
claims. Are there other relevant Federal agencies that VA could partner
with to streamline other claims processing?
Response. VA partners with numerous Federal agencies to streamline
claims processing. In addition to the IRS and SSA, VA also partners
with the Department of Justice, the Department of Defense, the Bureau
of Prisons, Health and Human Services, Department of Education, the
Small Business Administration, and the Office of Personnel Management.
VA is currently working with the Centers for Medicare and Medicaid
Services (CMS) to establish a new Computer Matching Agreement (CMA).
The purpose of this CMA is to enable VA to identify pension
beneficiaries who are receiving Medicaid-covered nursing home care in
order to timely adjust their pension payments to the $90 monthly rate
limit as prescribed by Section 5503(d)(2) of title 38, United States
Code.
Question 9. What outstanding requirements does VA need to meet in
order to complete integration with DOD by 2015?
Response. The Department of Veterans Affairs (VA) and the
Department of Defense (DOD) are making significant progress with
respect to sharing the information required to provide our
Servicemembers and Veterans the benefits they have earned by virtue of
their military service:
Personnel and Separation Data
- VA and DOD currently share personnel and beneficiary
information via the VA and DOD Information Repository (VADIR)
- VA needs, and DOD is working to share, the entire personnel
record by the end of CY 2013
Integrated Disability Evaluation System (IDES) Case Files
- VA and the Military Services have begun to share Integrated
Disability Evaluation System (IDES) case files electronically
at several pilot locations across the country. Approximately
3,100 cases have been successfully transferred electronically
as of December 14, 2012
- VA needs, and the DOD is working aggressively to complete,
the automation of the actual transfer of the IDES Case File
from DOD to VA without human intervention. This automation will
eliminate the manpower associated with the current manual
process, thereby freeing up valuable resources to be
reallocated to other IDES-related tasks
Service Treatment Records (STR)
- VA personnel have the ability to view Servicemember medical
records today
- Additionally, as noted above, the DOD has started to provide
the STR electronically to the VA for Servicemembers enrolled in
the IDES program
- VA needs, and DOD is aggressively working to provide, the
STR electronically at time of discharge for all Servicemembers
by the end of CY 2013
- VA needs, and DOD is aggressively working to ensure, that
all relevant medical information, including relevant
information related to purchased care, is included in the STR
provided to VA by DOD
Interagency Case Management and Care Coordination
Information
- VA and the Army currently share Care Coordinator information
- VA and DOD both need, and are aggressively working to fully
implement, the Interagency Comprehensive Plan (ICP) which will
expand the existing sharing mechanism to share a single
comprehensive care coordination plan amongst all DOD and VA
case management and care coordination programs.
Question 10. Assuming all outstanding VA claims are approved, what
would be the cost to provide the benefits and services claimed?
Response. As of March 14, 2013, 862,929 claims were pending for an
average of 280 days. If VBA granted all claims without regard for
eligibility, under payments, and overpayments, and started payments on
April 1, 2013, total obligations are estimated to be an additional $8.8
billion in 2013.
Of the pending claims, we assume 39 percent are claims for service-
connection, and the remaining 61 percent are claims for an increased
disability rating. VA assumes that claims for service connection would
receive a payment at the 40 percent rate as this is the average
disability rating for Veterans currently in receipt of compensation.
Based on historical information, on average, Veterans who reopen their
claims and are granted an increased rating change from a 40 to 60
percent combined disability rating. Obligations for these Veterans were
calculated by applying the difference in degree of disability average
payment for six months. All retroactive payments were based on 280 days
pending and have been factored into this estimate.
Chairman Sanders. Thank you very much, General.
Mr. Warren.
Mr. Warren. I have no statement, Mr. Chairman.
Chairman Sanders. OK. Let me begin by raising the issue
that Senator Isakson raised a few moments ago. In my view, the
goal of the VA--the very significant step forward in terms of
accuracy and processing claims in a rapid way by 2015--is a
very, very ambitious goal.
I think what you have heard this morning from people around
this table, from Senator Isakson and others, is, in some ways
we have heard this before.
The goal is a strong goal and I support that ambitious
timeline. The question I am asking you, General Hickey, is what
reason do we have to believe, what evidence are you going to
give us to suggest that you, in fact, are going to achieve that
very ambitious goal.
Ms. Hickey. Thank you, Chairman Sanders, for the question.
I will tell you that everything in this plan has been tried in
a real live environment in different regional offices across
the country. We are not just leveraging the pilots that we have
done for those initiatives; we are actually leveraging some of
the experience we have had from previous efforts to improve our
performance.
I will give you an example. While not a compensation claim,
one of the other major business lines that we have is education
claims. We started from a dead start in paper. We did not do so
red hot. It took us 49 days to do a claim for a student in
school.
In 2009, we brought on a first version of our long-term
solution, our paperless IT system for education claims, and cut
the time to do a claim in half and increased our quality.
Chairman Sanders. Are you suggesting that the technological
breakthrough you made in terms of processing student claims is
an indication of what you can do in terms of veterans claims?
Ms. Hickey. I am, Chairman Sanders, and I have a much
stronger word than hope. I now have a reality point to lay
before you all. Since 24 September 2012, we added a new
capability into the long-term solution that lets us take 50
percent of our claims, automate those claims where they come
in, and not a single person touches them. They fly through the
system and they are completed in a day.
Chairman Sanders. This is the student process?
Ms. Hickey. Absolutely, Mr. Chairman, this is the student
process.
Chairman Sanders. OK.
Ms. Hickey. Let me tell you what the results of that is now
that we have that new automated capability in the system.
At this time last year if I had been sitting before you as
I might have been on an occasion talking about education claims
backlog, I would have told you I had 200,000 claims in
inventory. Today I have 50,000 claims in inventory, because of
the speed of the automation, which helps us cross-check against
the rules, know that that student is where they need to be, and
getting the pay they need to get. The use of this automation
has really significantly improved the way we are doing
education claims this semester.
Chairman Sanders. OK. Let me ask you this. There has been
consternation on this Committee and I think within the service
organizations about the decision made by the DOD, I think it
was the DOD, not to go forward in terms of collaboration with
the VA in terms of the one system, one computer system for both
agencies.
What impact is that decision going to have in your efforts
to expedite claims?
Ms. Hickey. Chairman Sanders, I am going to first address
at a very high level what we require from DOD and then I am
going to ask my colleague, Mr. Warren, to address specifically
iEHR.
There are two major things that we need in order to decide
those claims that are in inventory and in backlog. Three out of
five times that we have an old claim it is because of this
issue.
We need data from DOD in terms of the complete medical
history of that member when they leave service in order for us
to decide a claim. We also need their complete personnel
records in order to know what their character of service is.
Without those, we must ask. When we ask, we have in legislation
today a 60-day wait period before we may ask again.
So, there is built into our process part of that problem.
As of January, I have an agreement with DOD, under the great
leadership of Mr. Fred Vollrath, now in OSD, where DOD now has
a new cell in every single service where they will gather all
records including TRICARE and contract medical records. They
will pull it all together. They will validate for me that it is
full and complete as of that time. They will put their
signature on top of that document and give it to me. That is a
game changer for us.
Chairman Sanders. So, is it fair to say that we are not
going to make the kind of progress we want unless there is
better cooperation between the DOD and the VA?
Ms. Hickey. DOD and VA cooperation is critical, absolutely
critical to our eliminating this backlog and to our doing
claims well. But specifically iEHR, I would like to defer to
Mr. Warren, who is more actively engaged in that process.
Chairman Sanders. Mr. Warren.
Mr. Warren. Mr. Chairman, to your question about a change
in direction, I think you would be surprised to hear that
everything we hear in the press is not necessarily correct.
Chairman Sanders. We are shocked by that, those of us on
the Hill.
[Laughter.]
Mr. Warren. And appalled. Sir, I would like to share with
you that we remain committed to that single, joint, common,
integrated electronic health record. We stay on that path. We
are on that path.
Chairman Sanders. Does the DOD remain committed?
Mr. Warren. The DOD has stated that they are committed to
the goal of reaching IOC, or initial operating capability, at
the two sites by 2014 and full operational capability by 2017.
The announcement that I think was misconstrued was that
because some progress had not been happening at the pace that
it needed to, we threw some accelerators in there. We said, let
us show we can do this. Let us show that we can deliver. If you
will, the PMAS (Program Management Accountability System) to
the iEHR approach. So the drive and the commitment was, now,
let us take Janus--the interface that we use to access both
systems--and accelerate it to seven more sites, and that is
supposed to be completed by July 31. The Interagency Program
Office (IPO) is committed to that.
Chairman Sanders. My time has expired.
Mr. Warren. Yes, sir.
Chairman Sanders. Senator Burr.
Senator Burr. Thank you, Mr. Chairman.
Mr. Warren, I read a release that was put out jointly. Your
interpretation is not what I read. DOD is headed for a totally
separate system. There is no assurance that it is going to be
integrated in a way that will talk to VA. As a matter of fact,
there is every reason to believe that if you talk to the DOD
folks, there are no plans to have a seamless, single system.
So, I will question that right from the start and I am sure
when the Secretary is here for the budget hearing, this will be
the subject of conversation.
Ms. Hickey, wonderful testimony. It almost makes me
embarrassed to ask questions that deal with facts, because I am
looking at a trend line as it relates to backlogs of disability
claims that, quite frankly, are just inconsistent.
You talk about the increase over the last 10 years. I can
look back just at last year to projections from the VA as to
progress we were going to make on disability claims. Certainly,
it took into account all the changes that you have seen for the
last 10 years. It took into account the Secretary's decisions
to extend additional benefits to Agent Orange victims. If it
did not, then we have a major problem within the VA on how we
plan.
But let me ask you. I think it is important for VA to be
completely transparent about the efforts to reduce the backlog.
In that regard, the backlog reduction plan VA submitted to
Congress notes, ``VBA is tracking execution of its
transformation plan against its key measures of performance
that are tracked daily, weekly, and monthly.''
To start with, I would like to ask you to provide the
Committee on a regular basis with those performance metrics,
particularly in the data that is not included in the Monday
morning workload reports and the ASPIRE Dashboard.
Do I have your commitment to do that on a monthly basis?
Ms. Hickey. Senator Burr, you are right in saying that
things have changed for us. Our demand has increased. That was
part of the reason for my focus on explaining what was in the
inventory for you. We have been now 10 years at war where our
men and women are 10 times more likely to survive than their
previous cohorts.
Senator Burr. I appreciate that. Do I have your commitment
to provide this Committee with those performance metrics on a
monthly basis?
Ms. Hickey. Senator Burr, I provide to this Committee on a
daily basis everything we do. As of last year, we are actually
transparent to a fault. Not just to this Committee, we have----
Senator Burr. General Hickey, this is a very specific
question. It is not broadly asked and I really do need a yes or
no answer. You state in your submission to Congress that VBA is
tracking execution of its transformation plan against its key
measurements of performance that are tracked daily, weekly,
monthly.
Can you provide us those on a monthly basis that are not
included in the Monday morning workload reports and the ASPIRE
Dashboard?
Ms. Hickey. Senator Burr, we will continue to provide you
and your staff the information we have provided and we will
continue to make it transparent to the world as we do today in
our ASPIRE Dashboard, in our annual reports, in our quarterly
reports, in the request that you asked for.
Senator Burr. I will take that as a no then.
Ms. Hickey. Thank you, Senator.
Senator Burr. Mr. Bozeman, as you know, when staff from the
Committee went to VA last week for a demonstration of the VBA
management system, it did not work. I do not think we need to
get into exactly what happened, but I would like to know how
often users in the field have IT problems that interfere with
their ability to process claims in VBMS?
Mr. Bozeman. Thank you, Ranking Member Burr, for your
question. You are correct. The demonstration to the staff was
conducted in what we consider a lower item level of buyer. It
is not the production environment of VBMS. So, we did encounter
some difficulties due to some changes we were making in the
software at the time.
So, I apologize to the Committee for that demonstration.
However, field users in production VBMS have sustained very
little outage time in VBMS over the course of, since generation
one software was available.
There would be isolated pockets which affect certain users
with certain roles from time to time. Those are reported on our
help desk. We isolate those issues, and resolve them as
expeditiously as possible, sir.
Senator Burr. Can you provide for the Committee the
percentage of time that that system is unavailable to those in
the field that are working on it?
Mr. Bozeman. I do not have that at my disposal. I will take
it for the record.
Senator Burr. Is that something we track?
Mr. Bozeman. Yes, we do track that, sir. Assistant
Secretary Warren may be able to provide further insight on
system outages.
Response to Request Arising During the Hearing by Hon. Richard Burr
from Matthew Santos, Congressional Relations Officer, U.S. Department
of Veterans Affairs, OCLA
Provide details on the time lost due to problems with VBMS/VBMS-R?
Response. The VBMS application itself has experienced little down
time prohibiting users to process claims. Between December 6, 2012, and
February 20, 2013, the VBMS application experienced a total of 2 hours
and 43 minutes of unplanned downtime over the course of two production
outages:
On December 6, 2012, users were being redirected to the
VBMS login screen when they attempted to change tabs while in the
rating application. The issue lasted for two hours and 13 minutes. It
was determined that a security certificate on a VBMS server was not
properly renewed during an anticipated service interruption which
occurred the previous night. The certificate was redeployed to the
affected application server and it was returned to service.
On February 20, 2013, users were unable to access the
rating application for 30 minutes due to a stuck thread. The server was
restarted and access was restored.
A VBA system wide outage occurred on January 28, 2013. The VBA
corporate database became unavailable for 1.5 hours when a system board
housing the corporate database at the Austin Information Technology
Center (AITC) failed. During this unavailability, users were unable to
access VBA applications including: VBMS, VETSNET, and Virtual VA.
Senator Burr. I hope that would be provided to the
Committee.
General Hickey, according to your plan for reducing the
backlog, VA's goal is to have 20 percent of the claims fully
developed at submittal during fiscal year 2013.
At the time VA released that plan, only 3 percent of the
claims were fully developed; and according to your testimony,
it is now 4.8. Tell me, if you will, how are we going to get to
20 percent?
Ms. Hickey. Thank you, Senator Burr, for the question. I am
going to say that the way we are doing that is with the
absolute dedicated commitment of our partners in our veterans'
service organizations. Specifically, a new effort led by the
American Legion, DAV, VFW, and others; they are working hard to
help us with that.
Senator Burr. How did you come up with 20 percent? Why was
it not 40?
Ms. Hickey. Today, 60 percent of the time our veterans are
represented by one of these VSOs in our system of both
inventory and backlog.
So, we took the opportunity to say let us start, let us
ramp up, let us grow in our capability for our VSOs to help us
do that part of our claims development effort that takes the
biggest amount of time.
Senator Burr. So, if we do not hit 20 percent, what effect
does that have then on the backlog problem that we have?
Ms. Hickey. So, the 20 percent is a relatively new target
that we have and we have asked our VSOs to help us with. They
are eager, they are involved, they are engaged, they are
training right and left on how to do that with their
representatives who are in the field working every single day
with the veteran.
Just for example, very quickly, those VSOs have more face-
to-face contact when that veteran is working with them, and
they have the opportunity to say, OK, you are claiming this
condition, do you have a copy of your medical records or your
private medical records that will help us make that decision
for that rating condition. Our VSOs are critical partners in
our effort to do this.
Senator Burr. Thank you, Mr. Chairman.
Chairman Sanders. Senator Tester.
Senator Tester. Thank you, Mr. Chairman.
I am going to go back to a point that the Chairman and the
Ranking Member talked about, and that is, that I think
partnerships are critically important. You talked about VSO
partnerships. I think there is another partnership out there
that is very important and it is with the DOD.
The Ranking Member noted that the DOD is on a totally
different plane and that a single seamless is not on the so-
called DOD radar screen.
I do not know if that is true or not. If it is, it is very
disturbing. That is not your problem. That is our problem, to
make sure that the DOD steps up to the plate and does what they
need to do so you can be successful in what you have to do.
Could you give me any kind of analysis without throwing DOD
under the bus, but please do if it is warranted, on what they
are doing as far as helping you out making sure that there is a
seamless transition for veterans?
Ms. Hickey. Thank you, Senator Tester, for your question.
There are many things that have been happening over the last
year in agreement with DOD.
First of which I already described. They have now made an
agreement with me as of January to give us 100 percent
certified full and complete medical records. We have never had
that in our history before. We have had to go look for those
records. They are now going to give them to us.
Senator Tester. Is that effective immediately?
Ms. Hickey. It is effective immediately. They are doing it
right now. Every single service has stood up a team across the
services. Every separating servicemember and every retiring
servicemember's records now go through this process with any
service and then they will come to me with that designation.
DOD is taking responsibility to ensure that the records are all
up to speed so I do not have to keep looking.
The second major effort that they are doing, and I think
this is important, is that they have a team of people now
sitting over with me to work on those really old claims that we
have not been able to find records to justify the decision we
want to make for a veteran. Their team is helping us to dig
through all of their archives to find those records right now.
So, those are two big areas where they are working with us
very closely.
Senator Tester. What can they do better?
Ms. Hickey. They are working on it with us more
effectively, but we still need to work on getting those papers
that they will give me over the next year converted into images
sooner and turned into a system that they will now have in 2013
called HAIMS, the Health Artifacts and Information Management
System, which will bring the records in electronically to me so
I can get those images across without having to deal with more
paper coming in the door.
Senator Tester. All right. How about your partnership with
groups like Social Security and the IRS?
Ms. Hickey. I have a really good new story to tell you
about that. I have had strong new relationships with both SSA
and IRS. They have critical information on earned and unearned
income for us to be able to make decisions very quickly,
especially for our folks who are the most destitute in our
environment.
Social Security and IRS have now made a decision to give us
access to current data every week rather than once a year. The
good news for our veterans is I have been able to take 100
people that used to have to spend 4 months doing nothing but
matching and looking for earned income and validating earned
income out of a year old's worth of database, and I now have
them pointing at doing DIC claims which are our most vulnerable
widowed and orphaned individuals, getting them the resources
they need faster.
Senator Tester. OK. A different area. From your
perspective, what role does insufficient staffing play in the
backlog?
Ms. Hickey. Good question. I want to thank this Committee
for the staffing we do have. I want to thank this Committee for
the growth in budget that this organization has never enjoyed
before this Administration and so thank you very much.
I am reluctant to say let us throw more people at a problem
where I have the capability to potentially make the work go
faster by the nature of the change in the process we are doing
and the changes in the technology.
By example, when we went into a paperless environment for
our loan guaranty efforts, we reduced the amount of work that
had to be done by people because the system assisted or because
the process assisted.
I know we are all in a difficult economic environment. I
would prefer to not make your life harder generating more
people when I think that I might have oxygen in the system
associated with what we are doing in the people aspect, the way
we are organized and trained to do the work.
You want me to be the most efficient, right? You want me to
be the most effective, right? I want to get the efficiency and
effectiveness out of a 1950s industrial age process, and bring
us into the 21st century. If I get through that and I still
need more people, I will come to you.
Senator Tester. I certainly appreciate that perspective and
appreciate the lean and mean and efficiency perspective, and I
know that you are committed to making sure that this problem
gets solved.
I am out of time, though I would love to talk to you about
the Ruth Moore Act, which I think I will put in questions for
the record for you to answer.
One other thing, if I might have the liberty, you talked a
little bit about a 60-day window where you could ask veterans
for information and you had to wait another 60 days.
Ms. Hickey. We do, Senator Tester. By the current rules,
when we asked for records, we must wait a 60-day waiting period
for a response.
Senator Tester. Is that an internal rule or is that a rule
that we have set up?
Ms. Hickey. I believe that that is in legislation.
Senator Tester. OK. We may want to visit about that.
Chairman Sanders. Thank you, Senator Tester.
Senator Isakson.
Senator Isakson. Thank you, Mr. Chairman.
Mr. Warren, the VA Inspector General reported that the
partial VBMS capability that has been deployed to date has
experienced, ``system performance issues.'' What are those
system performance issues?
Mr. Warren. Thank you, Senator, for that question. I would
like to point out two items, if I could. The first is that
report was issued in September, last September. So, it was
dealing with the pilot prototype system. Two, the Department
did not agree with the conclusions that the Inspector General
reached in their report.
Senator Isakson. So, you have had no system performance
issues?
Mr. Warren. We had performance issues with a pilot system
that was deployed whose intent was to find the issues we needed
to solve before we reached full deployment of a first
generation system. So, the report basically stated what we were
trying to do which was to put it out there, put it out there
fast, find out what works, find out what does not work. Make
the improvements, and then deploy it against the enterprise.
Senator Isakson. And that process has worked?
Mr. Warren. That process continues to work. We are using an
agile methodology. So, one of the things that you will see
different we applied it to Chapter 33 as a rolling change, add
functionality, add capability is we get systems out there. We
get capability out there quicker. We are not waiting 5 years to
design a system that fails. We are making changes. We are
deploying them every 3 months.
On some systems like eBenefits, we make deployments every
month. The goal is to get capability in the hands of the user
so we can evolve it, we can improve it, and bring that benefit
to the veterans along the way.
Senator Isakson. In Secretary Hickey's testimony--I think I
wrote this down right--she said the redeployment of VBMS was in
full swing from portal to decision. Is that an accurate
statement?
Mr. Warren. That is an accurate statement.
Senator Isakson. Then let me follow-up because I was not
questioning it but I wanted to make sure it was accurate
because, as I understand, and I could be wrong; this could be a
problem. But I understand that is accurate with regard to
pretty simple decisions that are made in terms of rating
claims, but complex cases which, as the Secretary has mentioned
that they have grown, is VBMS capable of making rating
decisions on complex cases?
Ms. Hickey. Senator Isakson, if I can answer that question,
yes. That is the short answer. In a very old version, the pilot
version of this last summer, there was some restriction to
limit it to claims with less medical issues. Not anymore.
We now rate everything. In fact, if you are one of the 20
stations that are now live on VBMS, every new claim you have,
whether it is an original one or a supplemental one, as it is
coming in the door now immediately gets turned into the
electronic environment. It is scanned, it is uploaded, it is
ingested electronically; and we are not bringing the paper
through the system from this point forward.
Senator Isakson. What software does VBMS run on?
Ms. Hickey. I will defer that to my IT colleague.
Mr. Warren. Sir, we could probably spend a couple of hours
walking through all of the different pieces.
Senator Isakson. Let us not do that.
[Laughter.]
Mr. Warren. So, I do not think you would like to.
So, when we talk about VBMS, we use Internet Explorer which
is the browser. We use Windows 7 which is the desktop. We use
an Internet Explorer server. So, there are a multitude of tools
that we use. We use Oracle at the back-end. This is not a pitch
for any of those companies. But again, we are using the tools
that are used in industry today for these types of systems.
Senator Isakson. Do you use SAP?
Mr. Warren. No, we do not use SAP.
Senator Isakson. That is good. OK.
My last question. On the transfer of medical records from
DOD to the Veterans Administration, that is done electronically
now?
Ms. Hickey. Today's medical records we received in paper.
Senator Isakson. When you have fully installed VBMS, will
DOD be able to transfer information electronically?
Ms. Hickey. So, Senator Isakson, that is a great question,
and that is exactly what we are planning for with the new HAIMS
system that the DOD is building, which will be delivered
December of this year. The intention is for them to upload
those claims into an electronic system that feeds directly into
VBMS.
Senator Isakson. Thank you very much.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you, Senator Isakson.
Senator Begich.
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Thank you, Mr. Chairman.
Let me follow up on that last question. I thought I read
something that DOD had some issues with their electronic
transfer of the records.
Ms. Hickey. Senator Begich, the part that I am talking
about is a different agreement that I have with DOD where they
are consolidating and pulling together all their paper medical
records in order to give it to me to make a decision, full and
complete records with their TRICARE and their contract medical
records.
I think the issue that you are talking about is iEHR and I
will defer that question to my colleague, Mr. Stephen Warren.
Mr. Warren. So, if I could do just a quick sidebar in terms
of the different terms that are used out in the popular press.
Interoperability is the movement of information back and
forth. There is the movement of medical information, clinician
to clinician today from DOD to VA. There is a translation that
takes place. It is not all the data. It is a limited amount of
data.
Senator Begich. Electronically?
Mr. Warren. Electronically. So, there is a limited flow. It
is not the full treatment record.
Senator Begich. Correct.
Mr. Warren. So, as a servicemember comes in to a VA
facility--either Guard, Reserve--and now they are a veteran
when they come over, we see some large percentage of data, not
all of it. So, that is interoperability.
The announcement that came out recently dealt with the goal
to get to that single, joint, common, integrated electronic
health record.
Senator Begich. Right.
Mr. Warren. One system so you do not have to worry about
translation.
Senator Begich. Right.
Mr. Warren. It supports that goal of the virtual lifetime
electronic record.
Senator Begich. Right.
Mr. Warren. So, when that citizen raises their hand like I
did coming into the service, the data gathered from there
forward is part of the benefits determination for compensation.
Senator Begich. Right.
Mr. Warren. The larger issue.
The VA is committed to that single integrated electronic
health electronic health record.
Senator Begich. I get that the VA is. It is the DOD, and I
guess--Mr. Chairman, one thing that would be unusual but maybe
we should have is DOD sitting here because I was on the Armed
Services Committee 4 years and they still cannot get an audit
of DOD. It is one Federal agency that cannot get their act
together when it comes to figuring out how to audit what they
do over there.
So, I understand that you have an agreement. But I have
been here now four years and claims--and I saw a scathing
report which, of course, Alaska was highlighted in there for
delays in disability claims.
The number 1 issue I get in my office is the lack or
inability to get these records and determine disability claims.
On top of that, it is this ability to get the records from DOD
over to VA.
You are putting a lot of faith in DOD who still cannot even
do an audit of their own functions--the only agency in the
Federal Government.
So, can you actually say right here--and you said it a
couple of times. I want to hear you say again that at the end
of 2013--because that is what I heard you say--we will be
moving electronically the full records from DOD over to the VA
so that I do not have to spend time with my staff on a regular
basis calling up DOD saying, ``What the hell, where is the
information,'' and then, ``VA why do you not have it yet?''
Ms. Hickey. So, Senator Begich, what I will tell you----
Senator Begich. That is a very simple question. Yes or no.
Ms. Hickey. And the very simple answer is I will have
images from the record. He will not have data yet.
Senator Begich. How are you going to get to that point, I
mean, getting the images? First off, I was somewhat surprised
and I thought the answer that DOD now is just kind of shipping
over boxes of material. I am simplifying it but it is paper
material, right?
Ms. Hickey. It is largely.
Senator Begich. So now, you have a contractor that is
scanning all this stuff which I have questions on its ability:
how fast it is moving; efficiency; your own ability to audit
that.
But then you just get a pile of images. You know, I can
scan stuff all the time and get a pile of images. How you
interpret them to determine the outcome for that individual who
is trying to get a claim?
Ms. Hickey. Senator Begich, that's a great question. I will
tell you how we did it. We used to take a stack of paper this
big with peoples little rubber finger tips on their fingers and
their eyeballs while trying to remember their rules in their
head and that is what we asked our hard-working employees, 52
percent of which are veterans themselves.
Today in VBMS, they do not deal with the paper. Their
rubber fingertips are gone. They do not have to remember all
the rules. They are built into the system. The images come
through. They can Google search throughout these document to
find that information. That is what VBMS does for us.
Senator Begich. Right. On new claims?
Ms. Hickey. On all claims coming in the door today whether
they are a Vietnam veteran, a World War II veteran, or today's
veterans.
Senator Begich. Do you have data that shows the difference
between the process time, the results, and efficiency between
the ones that are now coming in versus the almost millions
sitting in the backlog?
Ms. Hickey. Senator Begich, I will have it. I have just put
20----
Senator Begich. When will you have it?
Ms. Hickey [continued].----ROs on it on 28 January, on what
I consider, for the first time, the portal to decision
processing.
Senator Begich. Right. When will you have that?
Ms. Hickey. I am measuring it all the time. So, as soon as
I have a valid enough sample to give you, I will give it to
you.
Senator Begich. I want to go back to Senator Burr's
question. It seemed like such a simple one. You obviously do a
monthly matrix of some sort. It sounds like even weekly with
now some of the data given on earned income.
But can you just answer that question very simply? That you
will provide--I heard your answer. It was kind of a stock
answer that data that we request we will provide.
The matrix that you have--because I know, as a former
mayor, every agency in my department that I operated and
managed had dashboards that gave data and weekly, daily, and
monthly on the accessibility.
I echo what Senator Burr asked and that is, will you
provide that data on a monthly basis so we understand the
success or failure; because, honestly, when I look at the
numbers, 4 years later from my time here it is not getting
better.
I can tell you the increase in calls that I get in my
office are not going down. So, answer yes to Mr. Burr's
question or no. I do not want the stock answer that I know you
all get because OMB does sanitation to all your commentary.
I just want to know the real simple answer. Yes or no.
Ms. Hickey. Senator Begich, I will provide information to
you.
Senator Begich. Yes.
Ms. Hickey. I will provide information to you, yes.
Senator Begich. There we go.
OK, Mr. Burr, we maybe got halfway there; three quarters of
the way.
This will be the last comment, Mr. Chairman, thank you.
The VSOs do so much good work. It almost seems like they do
all this work and then VA duplicates the work and it seems like
we should figure out some partnership where VSOs can help us
move some of these claims because they do a lot of work on that
front. They have about an 80 percent hit rate. That is not a
bad success rate based on the history here.
I will leave it at that and maybe ask for the record, Mr.
Chairman, if that is OK.
Ms. Hickey. Chairman, may I answer that question?
Chairman Sanders. Briefly.
Ms. Hickey. Senator Begich, we have a very deep
relationship with our VSOs which is getting stronger every day.
They are on VBMS with us. They are inside the fence line now
more than they have ever been before. I am working very closely
with them and am very thrilled with their willingness to do
fully-developed claims which, in fact, will help exactly the
issue that you are discussing.
Chairman Sanders. Senator Heller.
Senator Heller. Thanks for holding this hearing. This is
good. This is really what we need across this country and in
Nevada obviously I get the same phone calls that the other
Senators are getting.
I certainly do appreciate Senator Tester's remarks. I am
glad he is across the way. We have a tendency of marching,
looking down the same road here. He made a comment that I want
you to clarify that perhaps I do not understand, and that is in
your testimony you stated that by law the VA must wait 60 days,
by law.
Ms. Hickey. Yes, Senator.
Senator Heller. It is not part of your manual. It is by
law.
Ms. Hickey. Yes, Senator, and then if I ask 60 days later
and I do not get it, I must wait another 30 days.
Senator Heller. By law?
Ms. Hickey. By law.
Senator Heller. OK. So, you have a claim and you called the
VA's office or you fax them or whatever it may be. You set that
in a file for 60 days. You do not do anything with it. You just
wait for 60 days; and if you do not get a response, then you
respond after 60 days; and then you must wait another 30 days.
Ms. Hickey. So, Senator, it is not that I do not do
anything with it. We do many things with the claim besides
that. We will continue to gather other evidence. We bring in
private medical evidence from our veterans. We will get that.
We will get our medical records; if the veteran is already
seeing a VHA doctor, we will pull that in. We will continue to
try to do everything we can to get that claim further down the
process. But then we will, on occasion, more than one occasion,
hit a brick wall.
Senator Heller. Let me move in a different direction with a
similar question, and that has to do with the GAO report. Tell
me if this is accurate.
When obtaining Social Security Administration records,
VBA's policy manual instructs claims staff to fax a request for
medical information and wait 60 working days to follow up if
SSA does not reply. Then, staff faxes a follow-up request and
then waits another 30 days.
Is that part of your manual or is that also by law?
Ms. Hickey. It is also by law, but it is no longer an issue
because now Social Security and IRS are giving us weekly data.
We have made agreements and are actually already seeing the
flow of that information. I am very appreciative to our Social
Security and our IRS partners in that effort.
Senator Heller. OK. So that is solved.
Ms. Hickey. It is solved.
Senator Heller. I was going to say because that would make
it about 25 percent more efficient, 25 to 35 percent more
efficient if we could take those filings and at least make a
phone call.
My staff, you know, we get a number of cases and we get
2500 cases a year; and we work with the same agencies you work
with; and if we do not get an answer within 5 days, we pick up
the phone and say, hey, where is our answer? We do not wait 60
days, we do not wait 30 days. But, of course, by law we are not
limited to those delays.
Let me ask you another question, and I certainly do
appreciate the good hard work of the VA. My father is a
veteran. He turns 80 this year. He has received some really
good service from the VA, the hospital in Reno; and I certainly
have nothing but praise, nothing but praise for these hard-
working individuals.
I have been to, though, the VA claims office in Reno; and,
as I mentioned earlier in my comments, we are some 10,000
claims behind.
Over the last 5 years, I have consistently asked them, what
do you need? What do you need? Do you need more individuals? Do
you need more resources, bodies? What is it going to take to
fix this backlog? And they have consistently told me we are
going to solve this without additional resources or without new
bodies.
I had it here a second ago; but according to the GAO
report, it said according the VBA officials, staff shortages
represents a primary reason for backlog.
So, I guess I'll just ask the question again--and I think
you have touched on this but maybe you can reiterate--what is
the issue? Do you need more individuals, personnel, in order to
fix this backlog?
Ms. Hickey. Senator, thank you for your question. I have
been to the Reno office as well and it is a terrific group of
people out there working on behalf of Nevada veterans.
Senator Heller. Yes, it is.
Ms. Hickey. What I will say is the demand has risen, and I
will go back to saying we have done a million claims the year.
These hard-working folks out there want to do what is right for
veterans, want to do what is right for the family members.
Senator Heller. I agree.
Ms. Hickey. They are not only doing a million rating
claims, they are doing a million non-rating claims. They are
not only doing that, they are doing half a million pension
claims in the same year. They are doing 4.7 million medical
issues a year. They are producing at record, record levels on
behalf of our veterans. But the demand is coming in at record,
record levels.
The only way to go after this is to fundamentally reinvent
ourselves, which is what we are doing in this transformation
effort. You get to that many transactions in a year, you have
got to have the benefit of some automation, some rules-based
capability, all of which we have built now. We are continuing
to add functionality every 8 to 10 weeks to get some additional
rules and automation built into the system, to take some of the
load off a person manually doing this much paper out of the
system, to create that oxygen in the system so that the men and
women--the 20,000 employees I have across the Nation who get up
every single morning dedicated and committed to this mission--
have an opportunity to really meet the needs of our veterans,
their family members, and survivors as they truly wish to do.
Senator Heller. Thank you, General.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you, Senator Heller.
Senator Moran.
STATEMENT OF HON. JERRY MORAN,
U.S. SENATOR FROM KANSAS
Senator Moran. Mr. Chairman, thank you.
Madam Secretary, thank you for being here. You can sense
the frustration that many of us have on this topic and part of
it is that we have heard the potential for success so many
times without seeing the results that we want to see.
I heard this last week when Disabled American Veterans from
Kansas, The American Legion, VFW, all came in the office. This
now is their number 1 priority and the most significant
complaint that I continue to receive from Kansas veterans and
their families.
When I came to Congress, now sometime ago--I had served on
the Veterans' Committee my entire time in the House and now in
the Senate--it was always health care that was the hot topic.
Now it seems to me that the health care side of VA has done
things that apparently the benefits side has not because the
number of complaints about the quality and access to health
care has diminished significantly and the number of complaints
about benefits has increased dramatically.
So, I do not know whether there is a role model within the
VA; and while the health care side is not perfect, the progress
and improvements seem to be evident, so you may have a role
model within your own Department for guidelines.
In addition to that, I assume that you have consulted with
the private sector in trying to find out how they deal with
this magnitude of claims and I assume--these are questions, you
can tell me that my assumptions are wrong--that you have had
genuine and real conversations with the employees that you
describe as so loyal and so dedicated.
I often think that Federal agencies, and employers in
general, never take advantage or rarely take advantage of the
knowledge of their own employees who may have the best
solutions because they are the ones who deal with the issues
every day.
In regard to employees, is there a reward or benefit that
accrues for employees who provide timeliness and accuracy in
the benefit process?
And finally, what is the process that you have in place to
help the veteran who is in a dire circumstance?
Often the calls, the concerns, the conversations that I
have as a Member of Congress--and I would guess my colleagues
as well--are from somebody who is about to lose their home to
foreclosure or who say my dad is homeless and we have been
waiting on an answers from the VA on benefits that very well
may enable him or her to make their mortgage payment or get off
the street.
What process is in place that allows you to prioritize
those claims in which, if you fail to provide the benefits, the
veteran suffers dramatically?
Ms. Hickey. Let me start, Senator Moran, with the last
thing you mentioned which is how do we help our veterans who
are in the most dire circumstances.
We actually prioritize them. When we hear words like
terminally ill, we hear words like on the verge of
homelessness, we hear words like former prisoner of war, we
hear words like Medal of Honor recipient, we prioritize those
above all other claims.
We routinely pull those out of the process and we raise
those up and we do those quickly. So, I will start there by
answering that question very clearly.
Second, I will tell you that everything in this plan did
not originate at 1800 G Street over in VA. In fact, every one
of the initiatives that are in this plan were pulled together
by including the thoughts of our employees. Many of the
initiatives are employee-generated initiatives. We could not do
it without them.
We have industry partners who are part of the process of
helping us think this through. We have had conversations with
Federal agencies that have gone through this before. I was at
the IRS yesterday--we have meetings with them frequently--
talking about how they went paperless, what were the issues
that they saw, how can we prevent those issues as we go
paperless. It's the same with Social Security.
We have definitely partnered with our VHA partners in doing
this; and I would just say, VHA enjoyed the benefit of
resources that VBA did not until 3 or 4 years ago. We were not
so high on the priority budget list. We have been now and--I am
so appreciative of that over the last 4 years, but we were not
prior to this. Certainly not on the IT priority list. We are
now. That is a very positive thing.
But the last thing I really want to tell you is I leave
today from this hearing and I go do what I have been doing for
the last 4 months. I get on a call with staff in all of our
regional offices who are in VBMS today, all the way down to
bargaining unit employees, and I ask them to tell me the good,
the bad, and the ugly.
We do it every week. I make every one of the program
officers in there, all the IT people listening and these folks
tell us like it is. When they do so, I take it, I task it, we
get it fixed, and we get it done so that it gets better every
single time.
The people who are making VBMS today better are not our IT
friends. It is our subject matter experts in the field who are
getting on the system going bang, bang, bang on the keys,
saying if you did that thing for me I could go much faster.
They are doing that today by the bucket loads. I am so
appreciative of getting that bargaining unit level employee's
input into our process and make sure that I get it every single
week. I do not miss that phone call.
Senator Moran. Thank you, ma'am.
Chairman Sanders. I thank you. You have stimulated
interest, and there is a desire to ask you some more questions.
So, we will go a second round.
Let me start that off by asking you something that I
probably should have asked you at the very beginning. You know,
we have talked about the 60-day requirement. We have talked
about perhaps impediments in law.
The goal of everybody up here is to see the claims process
move as rapidly and as accurately as possible--no difference of
opinion.
If you were sitting here as a lawmaker, what changes would
you make to help expedite the process, and say a few words. I
know there are differences of opinion about the 60-day
requirement and some of the VSOs have concerns about due
process and so forth. Say a word about that but tell us what
you would do up here in terms of law as to what we could do to
expedite the process.
Ms. Hickey. Thank you, Chairman Sanders.
First of all, I will tell you our appeals process today--I
could take 100 days and shave it off tomorrow if I had a
standard notice of disagreement form. I do not. Our veterans do
not have a standard form to appeal to us with, one that has all
the information we need in order to identify that appeal.
Frankly, we do not even know it is an appeal and we lose 100
days in the process.
So, we have asked for a standard notice of disagreement
appeal form. That is one way to cut the appeals process down.
We have a new 526EZ form, which, by the way, is online to
facilitate our online transmission like you do your taxes
today. What the 526EZ form does is it takes the requirements
for what has become a bit of a timeliness factor of back-and-
forth mail, puts it right up front on the form and tells that
veteran what we need from them in order to decide that claim.
This fulfills part of our due process, part of our VCAA
requirement, and when we do it electronically, I am not sending
letters back and forth and the veteran is not sending letters
back and forth. It has the ability to cut out time.
If that were a mandatory form, that would be better for
both the veteran and timeliness factors and it would be better
for us to continue moving that claim.
The other thing I will tell you is we are looking at this
issue--which today I know a lot about--our pension recipients.
I know they are in some of the most dire circumstances because
there is a means-tested environment.
I know when that pension veteran dies, today I am required
by law to make that pension widow send me a claim and go back
to the process to validate that pension. These are, for the
most part, poverty-level widows that I ought to just be able to
continue that pension, pay those pension widows at a very
difficult time in their lives and then go back and audit them
just to make sure that we are OK. I ought to have a period of
time where I can do that. We are looking at that issue. I would
need legislation to amend that issue.
Those are the kind of things we are thinking about. I have
78 percent of our veterans who are taking the GI Bill who tell
me today, quit sending me the letter, just post it on
eBenefits. I still have a requirement to send them a letter.
That is cost. That is FTE. That is mail. That is ink. That is
all the rest of those things.
Chairman Sanders. I appreciate your comments and I suspect
there is more that you are thinking about. I think this is an
issue that we should explore together.
Let me just ask you another question. As I understand it,
VBMS is today operational in 18 regional offices.
Ms. Hickey. Twenty today.
Chairman Sanders. Twenty regional offices, right. And your
testimony indicates that it will be deployed to the remaining
38 offices this year.
Ms. Hickey. We will have all 56 regional offices, yes,
Chairman, on it by December of this year.
Chairman Sanders. Given the problems that keep popping up,
are you confident that you can make that expansion work well?
Ms. Hickey. I am as of 28 January 2013. I believe I have a
solid, not perfect, but a solid, dependable portal-to-decision
system in place to be able to get more and more people on it,
to be able to check it.
Now, with that system in place, if I run into a problem, I
am going to slow down. I am going to be methodical, deliberate,
and I have demonstrated I will. I did it last fall.
We were going to accelerate and put on those first ROs by a
certain date. It had four major problems with it. I said, no, I
will not deploy this until we get those four major problems
fixed.
They did. They fixed them. They are gone out of the system;
and as a result, we went ahead and moved forward and now I have
20 stations on. There will be another five next week. That is a
solid system. Is it perfect? No. But our people will make it
perfect.
Chairman Sanders. All right. My time is expiring here but
what I would appreciate receiving from you as soon as possible
is a memo telling me the very specific ideas that you have as
to how Congress can move forward in helping the VA expedite the
process and improve accuracy. Is that something you can get me?
Ms. Hickey. I can, Chairman.
Chairman Sanders. OK. Thank you.
Ms. Hickey. Thank you, Chairman.
Chairman Sanders. Senator Burr.
Senator Burr. General Hickey, I sense a level of
frustration with some of the questions we have asked, and I
feel compelled to state to you that most of the questions deal
with prior testimony, prior goals established by you or within
the VA.
And I hope you do not take offense. I sense an obligation
on the part of the Oversight Committee to track whether, in
fact, you hit your goals and to fully explore if you do not
what the reason was, to look at goals for next year, and to ask
simple questions like what went into choosing that as a goal.
One of the goals that you have out there right now is that
the backlog is going to disappear in 2015. What is the plan if
it does not?
Ms. Hickey. So, first, Senator Burr, I will apologize for
my Irish heritage. Please do not interpret my hand-waving,
pilot-talking excitement and energy around what we are doing
right now as frustration; and I totally, totally understand and
believe that you have oversight over what I do and hope to be
very responsible to you in that regard.
So, my apologies for maybe perhaps projecting frustration.
Not there. Not there at all with you. I will deliver for you as
you need. But I have confidence that we will, in executing this
plan, be better positioned for anything that happens. We have
to do this. We cannot rely on the way we did things in the
past.
Senator Burr. We have wished a lot of years in disability
claims as we have seen the trend to go up, we have seen the
productivity of FTEs go down as we have added FTEs. You have
seen the charts. You know the numbers.
If the numbers are not right, again, I open up to you.
Prove to me where I am wrong. I look at them. But if it does
not work, what is the back-up plan?
What do we do in 2015 if, in fact, we still see a trend
going up of disability claims backlog? What do we do then?
Ms. Hickey. Senator Burr, you know one of my many jobs I
had in my past life as an Air Force veteran was to help deploy
quality management principles and practices and the idea that
you never stop thinking you have got a perfect plan. You
continue to look for ways in which to improve on what you have
done.
We will continue. From this point forward, we are doing it
today. We are not even resting on what is in the plan. We are
looking and delving into ways we can add even greater and
greater functionality to the system. We are looking for ways in
which we can shave off issues relative to accuracy.
By the way, I would just like to tell you, we have actually
this last year reversed a 4-year downward trend in our
accuracy. We have increased our accuracy nationwide by almost 4
percentage points and we continue to do that by an investment
that frankly is made in this plan, which is our new challenge
training, which has resulted in people doing claims faster at a
much higher quality level, as found by our quality review team
people we have in the system.
Senator Burr. Let me stop you if I can and I commend the
Chairman for asking for your suggestions in writing. I would
remind you, we have asked every year for the legislative
changes that need to be made to facilitate a faster, more
accurate system and, to the best of my knowledge, this is the
first time we have heard suggestions.
Hopefully, those are things that you are going to work out
with the VSOs because, as the Chairman said, VSOs have a little
problem with the 60-day wait for the due process. But we are
willing to entertain legislative changes where there is
consensus and where there is a belief that we can improve
accuracy and timeliness.
Is there currently a hiring freeze on claims processors
nationally?
Ms. Hickey. Senator Burr, there is not a hiring freeze on
claims processors, but I will tell you I am maxed out right now
for my end stream. I have everybody in a seat.
Senator Burr. But there is not a directive at headquarters
that there is a hiring freeze?
Ms. Hickey. No.
Senator Burr. OK.
Mr. Chairman, I am going to end questions there, but I do
want to loop back to something and it is something that Senator
Begich stopped on.
I am not going to ask the question again. I am just going
to state fact. I think that this Committee needs the
performance metrics that you do not find on the dashboard and
you do not get in the monthly report for us to do our oversight
correctly. I can only speak for myself.
If we do not receive that, I will do everything I can to
fence off headquarters money until the VA provides the
Committee with that metrics performance. So, hopefully, take
that back if, in fact, within the administration at VA that is
a bit of information they do not want to share with us, then I
will exercise the right of the Oversight Committee and the
Authorizing Committee and I will work with appropriators to try
to fence that off until we get it.
Thank you.
Chairman Sanders. Senator Tester.
Senator Tester. Thank you, Mr. Chairman.
I would just say I think we have got to be very specific on
what we are asking for if we are going to ask them to take time
to do it. That is all.
I think we need the information that we need to make our
decisions and hold them accountable but it has got to be pretty
specific what we are asking for and I do not mean to disagree
in the least.
Senator Burr. I will assure my good friend from Montana
that I will put it in writing. It will be very specific, and it
was specific.
Senator Tester. Metrics other than the dashboard; I think
we need to be more specific than that.
Senator Burr. I think General Hickey knows exactly what I
am asking for.
Senator Tester. OK. That is good because I do not.
Ms. Hickey. Senator Burr, I look forward to receiving your
request with the ones that you are looking for.
Senator Tester. OK. First of all, I appreciate your passion
and I think the Ranking Member is correct. We have asked and I
very much appreciate you stepping up to the plate and giving us
some good, solid, and I think pretty sound suggestions on how
we can eliminate some of the red tape, so I want to thank you
for that.
I want to clarify a little bit on the Guard and Reserve
medical records. Are they part of the guaranteed delivery from
DOD to VA?
Ms. Hickey. They are, but there are complications, Senator
Tester, with that. I will tell you that I have recently met
with all the adjutants general from all the States, including
yours, as well as the National Guard Bureau leadership here
just in the last couple of weeks to ask for their help in
getting a hold of National Guard records in particular, and I
hope to be meeting with the Reserve leadership soon to do the
same.
The complication with National Guard records are that they
have gone and served with units that are not in their States
over the last decade of conflict in Iraq and Afghanistan.
So, finding those records in other units in other States,
in other places becomes a very, very difficult task. What I
will tell you is the request I made of the adjutants general--
and I have already had five come forward and say you bet you I
will do it--is for them to stand up people who stayed active
duty, if nothing else, and help us go dig and find records on
claims that we have that are in the National Guard. I am very
appreciative of the National Guard adjutants general standing
up to that task.
Senator Tester. Well, I think it is very, very important to
get access to those records ASAP. These folks are being used as
active military at this point in time.
Ms. Hickey. I agree with you.
Senator Tester. OK. You are familiar with Quick Start and
VBMS discharge I would assume.
Ms. Hickey. Yes, I am.
Senator Tester. They have been described to me as pretty
ineffective. In fact, if they do not use them, they tend to get
their benefits quicker just going to the VA. Give me your
assessment and if you have heard similar concerns.
Ms. Hickey. Very frankly, Senator Tester, when we were
doing the Agent Orange work and when we were taking 37 percent
of our workforce out of the system, that was every bit of our
search capability across the country including all of the day-
one brokering centers. Those are our 13 resource centers out
there that handle national level work.
All 13 of those were pointed at doing the Agent Orange
Nehmer work. Therefore, what suffered in some respects, along
with every other cohort of veterans, was our BDD and Quick
Start work.
The better news: as of March last year, we redirected our
day-one brokering centers as soon as they finished the
veterans' Agent Orange claims, we redirected half of them
toward BDD/Quick Start work. We have cut the inventory in half
since doing that.
And then, when we finished the survivor claims in October,
we redirected more capability to work on the BDD/Quick Start
claims.
Senator Tester. So, I got that. What you are saying is that
the problem--because I am just trying to figure this out--the
problem was not with the DOD, it was with the VA. And it was
there because we gave you another job with the Agent Orange.
Ms. Hickey. Probably complicated by both. We still had to
get medical records. We still had to get TRICARE and contract
medical records but was less complicated by DOD in that process
than it was with us and the fact that we are doing Agent Orange
work. It took 37 percent of our workforce.
Senator Tester. OK. I got you.
We have heard conflicting feedback from the VA advocates
and employees regarding the role out of VBMS. Given the
dramatic implications on not only the veterans but their
families and the VA as a whole, there has been feedback that
says there should be an independent panel to take a peek at
what is going on. That has been the recommendation of the DAV,
in fact.
Do you think that would be appropriate, do you think that
would be necessary, do you think it would be beneficial?
Ms. Hickey. I actually use a lot of independent feedback
right now for doing this and have a lot of independent folks
that like to come look at us. In fact, I am going through
another OIG look and another GAO look right now since their
previous reports.
I also would say DAV and others have actually been very
instrumental in helping us build the VBMS. We brought them in
at the requirements development portion of building the new
paperless IT system. I depend heavily on all of our VSOs. I
meet with them monthly and more frequently, if necessary.
Frankly, I just took them down to Atlanta a month ago, and
showed them the whole process end to end.
Senator Tester. So, what you are saying is outside of the
DAV you are already using independent IT experts to review VBMS
and its plans and its progress and that kind of stuff.
Ms. Hickey. I consider GAO and IG people fairly independent
from VBA people and so I would say, yes. I have a fairly strong
group of people keeping an eye on us and I think that one more
set is not necessary at this time.
Senator Tester. Do they have the expertise in IT?
Ms. Hickey. I will defer to my colleague, Mr. Warren, on
that issue.
Senator Tester. Go ahead.
Mr. Warren. I think to your question, does it make sense,
is there value in inviting folks who know how to do the agile
development methodology come in and look at what we are doing
to make sure we are on the right path, makes sense.
We tried going down this path and we kept running into
Federal Advisory Committee Act (FACA) in terms of how do you
put advisory groups together. We have MITRE right now looking
at the architecture, pulling in externals but finding a group,
in the pure IT realm, because several times we have run into
the oversight folks from the GAO and the IG not having the
depth and knowledge necessary to truly understand what is
agile, what is iterative.
So, there is an interest. We have been trying to pursue it.
We've run into some roadblocks.
Senator Tester. Thank you. And once again I want to thank
you guys for your service. I appreciate the job you do.
Chairman Sanders. Thank you, Senator Tester.
Senator Johanns.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEBRASKA
Senator Johanns. Mr. Chairman, thank you for being here
today. Let me, if I might, follow-up on Senator Tester's
question about the oversight group because I, having sat in a
position similar to yours, you know; there was always a
willingness to put together an oversight group.
And as much as I value that, typically one of the things
that I do not want to have happen is that, of course, with a
new group everybody has to come up to speed. The group has to
come up to speed, and we might be inadvertently actually
slowing things down.
Do you have any thoughts on that?
Ms. Hickey. Senator Johanns, thank you very much for that
question.
It does suck up energy when we have to work with another
group for them to come in and look at it. We do not mind doing
that. That is part of the rule of oversight. We will do that.
But the very same people that are producing the data for
how we are doing are the very same people that have to pull off
that task and now go and start working at gathering data and
pulling data for new requirements that others need.
So, it is a burden. It is a necessary burden in life to
ensure that you are doing a good job. So, we will continue to
do that for OIG and GAO and our partners that you asked to do,
but it is a burden.
Senator Johanns. Yes. Let me ask you about the issue of the
medical records with National Guard and, I guess, Reserve too,
right? I note they are a part of the agreement. That would seem
to be pretty straightforward. You provide medical records.
But having said that, it is obviously not very
straightforward. I do not want to pull rank on anybody, but it
seems to me if you really need help with freeing up medical
records, let us know and we can also make that request. Now
again, I am sure that makes you a little uncomfortable, that
you are end running people that you are trying to work with.
But with the challenges you are dead stalled, right, until you
get medical records?
Ms. Hickey. For the final decision, yes, Senator.
Senator Johanns. Yes. Until that happens you cannot get to
a final decision I would not think.
Ms. Hickey. I can move the claim forward with the other
kinds of evidence that I can gather, but I cannot make a
decision on that claim; a rater cannot rate that claim until we
have those medical records.
Senator Johanns. Now, I am sure that is not the explanation
to everything, obviously, but how many cases would be out there
where you just simply need some medical records to move
forward?
Ms. Hickey. I will give you an example by looking at the
claims that we are really focused on right now, which are our
very oldest claims, our 2-year and older claims; and I will
tell you for every five of them, three of them are waiting
medical records.
Senator Johanns. That gives us a pretty good insight into
at least a piece of the problem and if we could somehow jar
that loose and you could deal with those claims in an
expeditious way, it seems to me we take a pretty sizable step
forward in dealing with these issues.
Ms. Hickey. It is a game changer, Senator.
Senator Johanns. It would really be a game changer. The
Chair asked you about a legislative approach. Again, I am
guessing you are feeling uncomfortable, my goodness, I am
trying to work with these people while somebody is pressing me
about there being another strategy.
I am interested in knowing and I think the Committee would
be interested to know, is there another strategy to try to
break the logjam here, get you medical records, get these
claims decided, and get these people the benefits they deserve?
Ms. Hickey. So, to give credit to my DOD friends who are
stepping forward with us through our joint governance bodies
that have been working this issue, we recently made the
decision between DOD and VA to do mandatory separation health
exams.
What that gets us is huge. That gives us a comparison
between when you came into service and when you separate. At
the time that you joined the military, you went through what we
call a MEPS station, and we went extremely deep on your medical
status at that time.
We do the same thing with a really good, strong, in-depth
separation health exam at the end of your service. We now know
everything that is service-connected between the two.
DOD and VA have been working on that idea and we have the
agreement now. We are digging in. The devil is in the details
and we are working that issue inside of our governance
structure process.
Senator Johanns. Can you give us any kind of a sense of a
timeline as to when you think you are going to work that
intergovernmental process to a result?
Ms. Hickey. Left to me, you know, the energy that you see
that can sometimes be seen as frustration is also the energy
you see on ``get 'er done.'' So, we are pushing hard to ``get
'er done.''
Senator Johanns. I would sure feel a lot more comfortable
if there were some way you could look out there and say ``get
'er done'' means 12 months or 18 months or something else,
because I think this is sizable. I think if there were a
breakthrough, you would be back here a year from now saying I
have got a great story to tell you.
Ms. Hickey. Senator, we have one of these meetings coming
up shortly. I will push to see if we cannot get some milestones
in place.
Senator Johanns. And we would love to hear about it.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you, Senator Johanns.
Senator Begich.
Senator Begich. Thank you very much, Mr. Chairman.
Let me follow up on that very good question by Senator
Johanns. In one of your comments you said, ``left to your own
devices.'' Is there something we can do to help with other
agencies or groups that you are working with?
Ms. Hickey. Senator, there are two groups I would say will
help us make this transformation. One is our private medical
physicians who can now give us medical evidence for 71 of our
81 major body systems that they fill out on a form called a
Disability Benefits Questionnaire. We shorten it to DBQ.
When they fill that out, those boxes are made to give us
explicitly the data that we need to make a decision. Today our
VHA doctors are giving us those forms, and have been since the
inception, and we have received 1.5 million of them. That helps
us to make that decision right the first time if it is filled
out completely.
We have about 15,000 since we have initiated this with
private medical physicians. Reaching out to the Nation's
private doctors and asking them to help us take care of these
veterans by doing DBQ's is another way to bring in the body of
the Nation's help for these veterans.
The second thing I will tell you is actually in the
veterans themselves. They can help us by bringing us the
medical records they do have, by giving us copies of their DD-
214, by filing online from this point forward, and then coming
online and using our VSOs.
I actually think we will have better, higher quality claims
if our veterans go to a VSO across the board for assistance in
bringing us in a fully developed claim, bringing us in all of
the evidence we need to make a decision on that claim.
Our VSOs are trained very well on how to do that. I rely on
them across-the-board, not only our VSOs in national
organizations, but our State and county service officers are
involved and engaged in that as well.
Senator Begich. Very good. Let me ask you. Do you keep or
can you develop--now that we are ending the second war that we
have been engaged in the last 10 years, are you able to say
over the next period of time, assuming certain growth rates in
the Army and the Air Force and other services, what the VA
numbers that you have to manage will be? Do you have such a
document you could share with the Committee? Do you see?
Ms. Hickey. Yes, I do.
Senator Begich. Can you project out and say, OK, by such-
and-such a day we are going to be----
Ms. Hickey. I do, Senator. I will tell you that I have
rudimentary capability. I will not tell you I have a model akin
to what the VHA has, but I am building it right now.
That is something we needed to do in VBA and we are doing
it now. I will tell you what will drive VBA's workload that is
different than the way VHA looks at it. VHA looks at it from a
veteran who is utilizing medical care. I have to look at it
from how many medical issues inside a claim will drive
workload. And that is a shift.
Senator Begich. A given variable.
Ms. Hickey. It is a different variable. Our World War II
veterans filed maybe 20 percent of the time with one or two
medical issues. Our Vietnam veterans filed three to four
medical issues maybe 25-28 percent of the time.
Today's veteran is filing at a much higher rate and with
many more medical conditions inside of their claim. Why? One,
we have done outreach, phenomenal outreach over the last 4
years. In fact, the year before last we touched 269,000
veterans. This last year we touched 609,000 veterans to teach
them about their benefits.
Senator Begich. Got you. Last question. When you mentioned
the National Guard, you mentioned there are five States that
have actually added personnel or done something internally to
help amend your work. Is that what I heard?
Ms. Hickey. This is a brand-new thing, less than a month
old. They have agreed to try to help us by standing up that
capability.
I will tell you one of the adjutants general that I believe
does the best of this across the Nation--he is certainly held
up by my personnel--is the Indiana TAG who has been helping us
remarkably well already. I believe he sort of sets the bar.
Senator Begich. A good model.
Ms. Hickey. A good model. He has people on the call, on the
phone, ready to go look for that veteran's medical information,
that veteran's personnel records to help us close on that
claim.
Senator Begich. Is Alaska one of those five yet?
Ms. Hickey. They are actually doing well in Alaska. I know
we have a new regional office director over there for the last
year and one-half. I am hearing very positive things about him
from your State director.
Senator Begich. Very good.
Ms. Hickey. I actually believe you will see Alaska's
numbers looking very good this year compared to where they have
been in the past.
Senator Begich. Very good. Let me end, Mr. Chairman, to
say, you know, we love our veterans in Alaska. We have 77,000
veterans, one of the highest per capita in the Nation, and the
VA does exceptional work. We have these challenges. You
recognize that we have to continue to work through them.
I just want to thank you and your team and the many people
who work on the front lines every day trying to deal with the
huge demands that are increasing literally daily on your
organization and other veterans' organizations.
So, thank you for your testimony. Thanks for suffering
through some of our questions.
Ms. Hickey. Thank you, Senator.
Chairman Sanders. Senator Blumenthal.
STATEMENT OF HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thank you, Senator Sanders, and thank
you for holding this hearing and thank you to our witnesses for
your service to our Nation.
General Hickey, I have been following some of your
testimony and I apologize if my questions may repeat some of
what you have already said. But I would like to take a moment
to focus on the ``people'' piece of the VBA's transformation
efforts.
I have heard from some of the employees in Connecticut as
to how they are evaluated in terms of claim processing, and
many have said that they believe that the system actually
values quantity over quality and accuracy. Accuracy obviously
is an extraordinarily important part of what they do.
Their view about quantity over quality and accuracy seems
to be inconsistent or contradictory to what you have shared so
far with this panel today. So, I wonder if you could please
expand on how the VBA evaluates its employees and incentivizes
high performance.
Ms. Hickey. Thank you, Senator Blumenthal. I will be happy
to do that.
First and foremost, I would like to say, the 20,000
employees that work in VBA every day are absolutely committed
to this mission in a way that is not driven by a job or a
paycheck.
It is driven by the fact that 52 percent of them are
veterans themselves; and when I go to ROs and I have been to 36
or 37 of them now--I've lost count--I talk to those employees
and ask how many of them have a direct family member who is a
veteran. Ninety-eight percent of the hands go up in the room.
That is why they do this job every day, and they come to
work every day working hard to try to make a difference for our
veterans and family members and survivors.
Here is what I will tell you. I have heard some of the same
things that you have heard. I am trying to change it. It is a
culture change. The way I am trying to change it is to have
made bigger emphasis over the last year and a half on quality.
My message to everyone is, it is not an either/or decision.
It is not production over quality but you also cannot spend
forever doing one claim and not get it done fast enough.
So, that is why I made a serious investment in challenge
training. We have totally redone the way in which we train our
personnel and there are great results as a consequence of doing
that challenge training.
In the past, basically you got taught somewhere between 1
and 6 months how to do it. You largely got a little curriculum
and your buddy next door that taught you how they did their
claims. That is how you got taught to do your claim.
Today we do not do that. We have a national curriculum
built by award-winning people who know how to develop
curriculum, that are trained to do that. There are pre-tests
and post-tests. There is actual live claims development in the
course. We check you at the 3-, 6-, 9-, and 12-month process to
see how you are doing and how you are sustaining.
The results of many of those classes now are the following:
if you are a new person who has gone through the challenge
training, in the first 6 months you are capable of doing 150
percent more claims than your predecessors who did not go
through challenge training at a 30 percent increase in
accuracy, and I have data to support that.
The second thing I have done is I took 583 people who were
doing claims off the line and I invested them into checking and
improving the quality of those claims. They have been doing
that under the name QRT, Quality Review Team, for the last
year. They are inside the ROs. They are trained to the
standards of our national quality team and they are managed and
monitored at that level.
I believe we had too much of a ``got you'' in this area so
what I asked those Quality Reviews Teams to do is take claims
that are in process out of the place where we nationally have
problems. You pull those claims. You find them. Where you see
an error, you go to that person, that employee and they fix it
now; it does not count against their performance.
It is a Mulligan, it is a do over. Fix it now. The benefit
we get out of that is, one, it is not a ``got you.'' So,
employees do not feel this overwhelming pressure.
Two, it is a training moment. They are now learning how to
do that right before they have gone three or four more months
of doing it wrong. So, we have data that shows we have caught
several areas and reversed those as a result of that.
The other thing that I will tell you that I have just done,
and we have just finished all the work to make it so, is look
at quality by individual medical issue. A veteran comes in to
us in the way you all see, I think many people see us in the
world as processing one claim. We do not do one claim. We do
all the individual medical issues that are each treated as an
individual claim.
Our people who are doing the claims, though, are not rated
on how well they did all of those individual medical issues,
which is where the real work is and where the real decisions
happen. Instead, they are rated on the overall claim. It is a
100 percent up or down vote.
So, if you have, as we are receiving today, 16-medical
issue claims and you do 15 of those 16 perfectly, and you miss
it on the 16th, you are not given a 90 percent. You are given a
zero.
But today I have changed the system. I am changing the
rules to say, your quality as an employee will be rated on how
you do individual medical issues, and then we will be able to
have a better conversation. We will be able to look at your
quality better according to where the real work happens at the
medical issue level.
I will tell you the results. I know already since October I
have 11 stations right now today that are at 98 percent quality
when I look at it as a medical issue level quality.
I have half my stations at 95 percent quality when I look
at them from the medical issue level. All of my stations but
two are above 90 percent quality when I look at them from the
medical issue level.
When I give you credit for the things you do right, but I
get you to re-do the ones you do not, I grade you on the ones
you do not.
That is what we are doing. That is what I am trying to do
to really help our employees understand it is an ``and''
equation. It is production and quality, and we are building
rules into the VBMS that help them with that. We are building
calculators that help them with that, all to drive their
quality higher.
Senator Blumenthal. I appreciate that answer, which was
excellent. It actually answered some of my follow-up questions.
But I want to, if I may, Mr. Chairman, ask one more quick
question. Or, maybe I will submit it for the record. It
concerns the transition from two separate electronic medical
systems to a single one. I know there have been questions about
it before, and maybe I can follow up, Mr. Chairman, with
questions submitted in writing.
Chairman Sanders. Absolutely.
Senator Blumenthal. Thank you.
Ms. Hickey. Thank you, Senator.
Chairman Sanders. Well, this brings our testimony to a
close. General Hickey and your staff there, this issue I think
you have heard from everybody up here is the major issue
concerning the veterans' organizations and veterans throughout
this country and this Committee.
So, we are going to monitor what you do very, very closely.
But we are not going to do only that. We need your ideas, as I
indicated earlier, and your advice as to how legislatively and
in other ways we can be effective in expediting the process and
improving accuracy. It is an effort that we are going to have
to work together on. I look forward to doing that.
Last, my wife is Irish. Your emotionalism does not make me
nervous. You have not thrown anything at me yet. So, thank you
very much for the hard work and the focus you are giving to the
issue. Thank you very much.
Ms. Hickey. Thank you.
Chairman Sanders. We will now hear from our next panel. Let
me thank our panelists for being here. I want to welcome Daniel
Bertoni, who is the Director of Education, Workforce, and
Income Security for the Government Accountability Office, the
GAO.
Following Mr. Bertoni is Joseph Thompson. Mr. Thompson
formally served as the Under Secretary for Benefits at the
Department of Veterans Affairs and currently serves as Project
Director with the National Academy of Public Administration.
Following Mr. Thompson we have Bart Stichman--I hope I am
pronouncing that correctly--who is the Joint Executive Director
of the National Veterans Legal Services Program.
And certainly last but not least, we have Joe Violante, who
does a great job as the National Legislative Director for the
DAV, the Disabled American Veterans.
Thank you all very much for being with us. Mr. Bertoni if
you could begin.
STATEMENT OF DANIEL BERTONI, DIRECTOR, EDUCATION, WORKFORCE,
AND INCOME SECURITY, U.S. GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Bertoni. Mr. Chairman, Ranking Member Burr, Members of
the Committee, good morning.
I am pleased to discuss the Department of Veterans Affairs
disability compensation claims process which paid over $39
billion in benefits to over 3 million veterans last year.
For years, VA's disability process has been the subject of
concern to many due to long waits for decisions and large
numbers of pending claims. Moreover, since 2009, VA's backlogs
of claims has more than tripled to nearly 600,000.
My statement today is based on our December 2012 report and
discusses factors contributing to the lengthy claims and
appeals processing and the status of VA's efforts to improve
service delivery.
In summary, we found that rising workloads along with
program rules and inefficient processes have contributed to
lengthy processing times. As the population of new veterans has
swelled in recent years, the number of claims received by VBA
increased 29 percent over 2009 levels.
These claims generally have a high number of disabling
conditions and often involving impairments which make their
assessment more complex.
Moreover, due to new regulations establishing benefit
eligibility for new diseases associated with Agent Orange
exposure, VBA diverted substantial staff resources from 2010 to
2012 to adjudicate 260,000 additional claims, further
exasperating workloads and challenging its ability to make
timely decisions for all claims.
Issues with design and implementation of the program have
also contributed to timeliness challenges. For example, the law
requires VA to assist veterans in obtaining all relevant
records from both public and private sources. However, delays
in obtaining military records, especially for Guard and
Reserve, and Social Security Administration medical records
have impacted the timeliness of decisions.
Program rules require steps to consider all evidence
submitted even if it is provided very late in the process,
possibly delaying a decision for several months.
Further, VBA's paper-based claims processing system
involves multiple handoffs which can lead to misplaced and lost
documents and cause unnecessary delays. As a result, the
evidence gathering phase alone of VBA's claims process took an
average 157 days last year.
VBA has a number of initiatives under way to improve the
timeliness of claims and appeals processing, although prospects
for improvement are uncertain. This includes using contractors
to assist with evidence gathering for nearly 300,000 claims and
shifting workloads from regional offices with large backlogs to
13 specialized processing centers.
VBA is also modifying certain procedures to speed
decisionmaking. For example, veterans can now receive expedited
processing for submitting claims that are certified as having
all required evidence. However, to-date very few veterans have
elected this option.
To decrease the time it takes to gather medical evidence,
VBA is also using contractors to obtain medical records from
private physicians and encouraging the use of standardized
forms for submitting information. However, results to date have
been mixed.
The agency has also redesigned its claims process model
whereby specialized teams triage and process claims based on
complexity. As of December 2012, VBA had implemented this
initiative at 51 regional offices.
Finally, the agency is developing a paperless claims
processing system which will ultimately allow staff electronic
access to claims and supporting evidence.
However, at the time of our review, the system was not
ready for national deployment due to a number of software and
performance issues. Despite these challenges VBA still intends
to fully implement the system by the end of calendar year 2013.
In conclusion, we have noted that VA's efforts to improve
the disability claims process should be driven by a
comprehensive plan. However, when we reviewed the documents, we
found that they fell short of established criteria.
Specifically VBA could not provide us with a robust plan
that tied together its many varied initiatives, their
interrelationships, and the subsequent impact on claims and
appeals processing.
We also noted that absent such a plan to manage and
evaluate the effectiveness of its efforts, the agency risks
spending limited resources on initiatives that may not
sufficiently expedite disability claims process.
Subsequent to our report and recommendations, the agency
published an ambitious plan to eliminate the compensation
claims backlog in 2015. While this plan includes additional
performance metrics and a discussion of implementation of
risks, it still falls short in the areas of performance
measurement, risk mitigation, and some key assumptions.
Mr. Chairman, this concludes my statement. I am happy to
answer any questions that you or other Members of the Committee
may have.
Thank you.
[The prepared statement of Mr. Bertoni follows:]
Prepared Statement of Statement of Daniel Bertoni, Director Education,
Workforce, and Income Security Issues, U.S. Government Accountability
Office
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Sanders. Mr. Bertoni, thanks very much.
Mr. Thompson.
STATEMENT OF JOSEPH THOMPSON, PROJECT DIRECTOR, NATIONAL
ACADEMY OF PUBLIC ADMINISTRATION AND FORMER UNDER SECRETARY FOR
BENEFITS, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Thompson. Thank you, Mr. Chairman and Members of the
Committee. I appreciate the opportunity to testify for the
National Academy of Public Administration regarding VBA's
efforts to transform its claims process.
Chartered by Congress, the Academy is an independent, non-
profit, and non-partisan organization dedicated to helping
government leaders address today's most critical and complex
challenges.
The Academy has had the privilege of working with VA over
the last several years on a number of serious issues. The VBA
has embarked on an important effort to automate and improve its
claims processing, and the Academy believes the agency is
taking some positive steps to accomplish this.
However, its ability to get the job done will depend on the
successful adoption of change management practices, some of
which are discussed in my written testimony.
Deciding veterans disability claims has always been a
complex and time-consuming task. In the post-9/11 world, VBA
has faced major workload issues which everyone in this room is
familiar with.
VBA's total claims processing capabilities have grown
significantly frankly from the time I was there until today.
Unfortunately, the claims work has grown even faster. I would
like to try to discuss some of the approaches VBA has taken to
the backlogs and the Academy's look at that.
The plan identifies strategies in three major areas:
people; process; and technology. Those are, in fact, the key
levers of organizational change. The Academy believes this is a
fundamentally sound approach and offers a number of suggestions
in the written testimony of the Committee and for VBA to
consider concerning potential implementation issues.
Strategic plans are important but, as the saying goes, no
battle plan survives contact with the enemy. It would be
surprising if there was not some important upcoming development
that fundamentally reshapes the veterans' claims processing
environment.
Because of this, resiliency and adaptability may, in fact,
be the most important organizational characteristics VBA will
need to prevail in its change efforts. Let me also say that the
breadth and scope of the change that is underway is massive and
we know the agency is moving heaven and earth to implement
these changes.
There are, however, a number of cautionary notes that the
Academy would sound that are offered for consideration
regarding the transformation process.
One, the agency does not appear to have much, if any, surge
capacity, that is, the ability to bring resources to bear if
circumstances require it. There is just no slack in the system
and we think that is a dangerous situation.
Second, the technological advances are the key, in the
Academy's opinion, to VBA's future. Having digital claims
records, using a rules-based claims systems, exchanging
information electronically, these changes will ultimately
transform the operation.
However, technological changes not only have an enormous
potential to make claims processing better in the long run,
they also have an even greater chance of making claims
processing more difficult in the short run.
This is typically what happens in large information
technology implementation efforts. It goes on throughout the
Federal Government. Glitches are the norm and time, serious
amounts of time are spent fixing them.
Some of the development difficulties with VBMS we believe
are evidence of that. The performance targets set for 2015 such
as the elimination of 700,000 claims and the backlog and making
decisions at a 98 percent accuracy rate are indeed stretch
goals.
In order to accomplish them, every initiative will have to
have worked precisely as planned, but as I noted that is not
the norm for these types of efforts.
Managing large-scale change, coupled with high workload, is
a balancing act; and given the extreme amount of work in the
pipeline and the comprehensiveness of the plan changes, it is
practically challenging for VBA.
Good communications with the people implementing these
changes are critical--I was glad to hear of the Under
Secretary's efforts in that area--to understanding its impacts,
as is taking the time to assess and continually reassess the
actual impacts in real time. This should lead to making
adjustments and accommodations to the plans. [Laughter.]
Just make sure you do not overwhelm your own people with
the changes. All of this, again, speaks to the need for
fragility and adaptability.
In closing, Mr. Chairman, let me state the Academy believes
VBA has taken important steps to bring about the fundamental
change everyone seeks.
However, the volume of work currently sitting in regional
offices combined with the extent of the changes underway make
achieving success no sure thing. To be successful, VBA will
need to manage this change with great care and will need
everyone's support, including Congress, the Administration, the
VSOs, in making sure that veterans and their families get the
help they need in the manner they deserve.
Mr. Chairman, that concludes my opening statement. I will
be pleased to answer any questions you or the Committee may
have.
[The prepared statement of Mr. Thompson follows:]
Prepared Statement of Joseph Thompson, Project Director, National
Academy of Public Administration
Mr. Chairman, Ranking Member Burr, and Members of the Committee, I
appreciate the opportunity to testify today on behalf of the National
Academy of Public Administration as to the Academy's perspective on the
efforts of the Department of Veterans Affairs to transform its claims
process. This is an important topic to our Nation, to the veteran
community and to me personally. I am a former career employee of the
Department of Veterans Affairs who was honored to serve as the
Undersecretary for Benefits from 1997 to 2001. As a Vietnam veteran, I
was fortunate to have the programs our Nation provides to help
returning servicemembers available to me. Without hesitation, I can say
these programs have served our Nation well and transformed the lives of
countless veterans and their families. I am one of those whose life was
made immeasurably better because of the help I received from VA. Since
retiring, I have had the opportunity to work with leaders in a number
of Federal agencies on business process improvements, primarily as a
senior advisor at the National Academy. It is in that capacity that I
am here today.
Established in 1967 and chartered by Congress, the Academy is an
independent, non-profit, and non-partisan organization dedicated to
helping leaders address today's most critical and complex challenges.
The Academy has a strong organizational assessment capacity; a thorough
grasp of cutting-edge needs and solutions across the Federal
Government; and unmatched independence, credibility and expertise. Our
organization consists of nearly 800 Fellows--including former cabinet
officers, Members of Congress, Governors, mayors, and state
legislators, as well as distinguished scholars, business executives,
and public administrators. The Academy has a proven record of improving
the quality, performance, and accountability of government at all
levels.
The Academy has had the great privilege of working with VA on a
number of critical issues. From 2007 to 2011, the Academy provided
advice on how VA can improve its service to veterans and sustain a
process of continual improvement; strengthen its Fee Care Program; and
develop effective national strategies to recruit and retain a high-
performing, diverse workforce. Specifically, the Academy established
independent Panels to help VA in the following areas:
Analysis of the Veterans Health Administration Non-VA
(FEE) Care Program. The Academy conducted an independent study to
analyze the current organizational model supporting the Non-VA Care
(FEE) Program, with the objective of providing the Veterans Health
Administration with options on the most efficient model for the future.
This assessment evaluated other Federal and commercial health care
programs, compared these programmatic structures with the current
structure, and assessed how other models might improve outcomes. The
Panel issued a number of practical recommendations for how VHA could
improve the management of this program.
After Yellow Ribbons: Providing Veteran Centered Services.
As part of a broader effort to help VA improve its service to the new
and preceding generations of veterans, in 2008, Congress asked the
Academy to study the management and organizational challenges facing
VA. The Academy conducted research and developed extensive knowledge of
VA, which was applied to assess the effectiveness of VA's
organizational structure, management, and coordination processes,
including seamless transition, used by VA to provide health care and
benefits to active duty personnel and veterans, including returning
Iraq and Afghan war veterans. The Academy Panel focused on the need to
ensure coordinated and effective services for those who return to
civilian life after having been severely injured while in combat. The
Academy Panel's report recommended actions to improve service to
veterans and sustain a process of continual improvement.
Recruiting and Retaining a Diverse High-Performing
Workforce. In September 2007, VA sought the Academy's assistance to
help address its national and local-level diversity disparities, as
well as diversity among its Senior Executive Service leadership. VA
sought an independent and objective analysis of its current practices
to ensure that the agency is able to acquire and retain the talent
vital to achieving its current and future core missions. The Academy
Panel identified an opportunity for VA to reshape the workforce;
improve diversity; and strengthen the healthcare, administrative, and
leadership pipelines needed to ensure the right competencies are in
place for the future. A specific area of emphasis involved identifying
recruitment and retention challenges that confront VA for its mission-
critical occupations as it seeks to improve the diversity profile and
strengthen the performance of its leaders and workforce. The Panel
developed a barrier analysis methodology, tools, and strategies to
assist VA in identifying structural, personnel availability, and
attitudinal barriers.
The Veterans Benefits Administration (VBA) has embarked on an
important change to automate and improve its claims processing and has
identified ambitious processing goals to achieve by 2015. The Agency
has taken some positive steps in designing and implementing a dramatic
transformation of its claims processing system, but its ability to
deliver will depend on its successful adoption of change management
practices, as well as continuing support from veterans service
organizations, Congress and the Administration.
As part of my testimony today, I will examine some the challenges
facing VBA's claims processing; discuss key principles of strategic
planning and change management, including effective practices elsewhere
in the Federal Government; and offer advice on how VA, the
Administration, and the Congress can best move forward in this critical
area. The Academy's Congressional charter precludes the organization
itself from taking an official position on legislation, and my
testimony does not represent an official position of the Academy.
``to care for him who shall have borne the battle * * *''
The Obama Administration has stated, ``[w]e have a sacred trust
with those who wear the uniform of the United States of America. For
their dedicated service defending the United States, veterans receive
an array of benefits and services.'' \1\ It is important to ensure that
we have a claims processing system that honors this trust. In essence,
VA is charged by the American people with fulfilling the social
contract that arises when a young enlistee raises his or her hand and
swears an oath to ``support and defend the Constitution of the United
States against all enemies * * *'' Whether debilitating wounds suffered
in combat or injuries suffering in furthering the mission of the United
States military, disabled veterans have earned their benefits through
their service.
---------------------------------------------------------------------------
\1\ http://www.whitehouse.gov/omb/factsheet--department--veterans
---------------------------------------------------------------------------
Deciding veterans' disability claims has always been a complex and
time-consuming task. New laws, court cases, and new program
requirements each add to the difficulty and length of the process. In
the post-9/11 world, VBA faces major claims processing challenges
driven by several factors: a surge in claims both from newly separated
Iraq and Afghanistan veterans as well as claims from older veterans,
including many thousands of dioxin exposure-related claims from Vietnam
veterans; increasing complexity of claims such as Traumatic Brain
Injury, as well as a significant increase in the number of claimed
disabilities to be decided in each claim; new laws and precedential
court cases which have driven claims volume increases and processing
delays; and difficulties in implementation new technologies.
These challenges threaten VBA's ability to meet its obligations to
process veterans' claims in a timely manner. Figure 1 shows the
downward trend in the veteran population from 2000 to 2036, a decline
which began over three decades ago. With a declining slope, the normal
expectation would be for a commensurate decline in VBA's workload. The
opposite is true. Driven by the increase in claims and the growing
complexity of the claims processing environment, VBA's workload is
actually increasing, and has been doing so for many years.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Figure 1. Projected Veteran Population (2000 to 2036)
VBA's total claims processing capabilities have grown significantly
over the last decade. Unfortunately, the claims work has grown even
faster. Overcoming this daunting complex of challenges facing VBA will
require transformation--an integrated set of changes in organization,
process, workflow, people/skills, technology, and culture.
vba's plan to eliminate the backlog
In January 2013, VBA released a plan, Department of Veterans
Affairs Strategic Plan to Eliminate the Compensation Claims Backlog
that outlines the efforts to eliminate the claims backlog and improving
decision accuracy to 98 percent in 2015. Those are very ambitious goals
and to achieve them, not only is a robust and thoroughgoing plan
necessary, everything will have to go exactly according to that plan or
the organization will have to be extremely agile in dealing with the
exigencies.
VBA's plan identifies strategies in three major areas--people,
process, and technology--that are the key levers of organizational
change. This is a fundamentally sound approach. Not only are these
areas essential to any large-scale organizational change process, they
all have a symbiotic relationship with each other:
The ``people'' approach has four cornerstones: improved
training; case management of claims; cross-functional teams to handle
the claims work; and triaging claims into those which can be done
quickly, those that require special handling, and everything else. Each
of these areas has been used successfully in many organizations and I
believe can be helpful to VBA in getting its work done:
- Training is a key lever because of the wholesale change VBA
is undergoing. Keeping up with process and technology changes
alone will be take considerable work but is absolutely
essential to organizational progress.
- Case management and cross functional teams are, in my
opinion, the best way to handle anything as complicated as a
veteran's disability claim. The ability to have ``end-to-end
ownership'' of a claim as well as a having a VA advocate to
help the veteran through this complicated process are both
extremely worthwhile efforts that should fundamentally improve
service to veterans and their families.
- Triaging can also be very helpful to increase productivity
and reduce cycle times. The dangers in its use is that it can
lead to ``cherry-picking'' the easiest claims and sometimes
results in employees being pigeonholed in single purpose jobs
over extended periods of time.
The ``process'' approach is concerned with improving
fundamental business processes. The initiatives described include:
- Disability Benefits Questionnaires (DBQs), which are forms
that physicians complete during an exam that contain explicit
medical information needed to decide a disability compensation
claim. This is a good idea that should improve productivity and
reduce processing times provided there is widespread
utilization. This is a good first step but in order to provide
the basis for transformational change, the data on the form
could automatically populate VBA's claims processing system and
generate a prospective award that a claims processor can
approve or amend, as necessary. This would reduce an enormous
amount of time required to re-key the data when it is received
from the physician and significantly shorten the ratings
process.
- Simplified Notification Letters initiative, which
automatically generates the text for veterans' claims decision
letters, is also on the right track in terms of saving time and
effort. A suggested metric VBA might want to use to evaluate
this new process would be to track the percent of veterans
receiving the letter who have follow-up inquiries or appeal
their claims, i.e., are they more or less satisfied with the
information they receive through this new process as opposed to
those veterans serviced under the old process?
- Fully Developed Claims are also a good step to reducing
cycle times but the volumes are disappointing. VBA's look to
incentivizing the process is a good step to take because every
claim that comes in under this process is not only a time and
resource saver for VBA but is also a significant improvement in
the service provided to veterans.
- Data exchanges with other Federal entities is absolutely
necessary and is an area which the Congress and the
Administration can play a key role in helping to convince some
of these other agencies to cooperate with VBA in building these
new systems. It has to be extraordinarily frustrating in the
year 2013 for VBA field staff to have to use fax machines and
search for unlisted phone numbers to secure information to help
veterans.
The ``technology'' approach centers on the development and
implementation of the Veterans Benefits Management System (VBMS), which
is a web-based, electronic claims processing system. This centerpiece
of VBA's technology approach has enormous potential to improve claims
processing but is not meeting its initial milestones. This will likely
prove to be the single most important change VBA is currently
undertaking.
A second technology effort involves the Veterans Claims Intake
Program (VCIP), which is an effort to scan claims folder documents into
an electronic environment. Having these scanned claims images will
provide VBA with flexibility in terms deciding how and where work gets
done and should reduce the amount of lost or misplaced documents but it
probably will not help improve productivity significantly. Looking at a
scanned image instead of a piece of paper does not necessarily make a
claims examiner's job any faster. The true productivity boost for
``electronic documents'' will come when their data automatically
populates VBA's claims records.
key strategic planning and change management practices
The transformation of VA claims processing is an important and
ambitious undertaking. VA has engaged in large-scale transformations
before--most notably, during the 1990s when VHA transformed the veteran
healthcare system into a high-quality healthcare benchmark for the
Nation. At that time, both internal and external stakeholders realized
that the status quo would not get the job done and that fundamental
change was necessary. While creating new organizational structures,
such as VISNs, the Undersecretary for Health decentralized power to the
field and established robust performance measures to ensure
accountability. The external environment, the leadership, and the
organizational design were all positive contributors to the
transformation.
In order for the promise of the claims processing transformation to
be fully realized, VA will need to adopt effective strategic planning
and change management practices. Both OMB and GAO have produced
guidance for the development and content of strategic plans.\2\ The
Government Performance and Results Act of 1993 mandated that every
major Federal agency develop a mission statement, set goals, measure
performance, and report accomplishments. The practice of requiring
strategic plans for components within agencies was a natural outgrowth
of this requirement since component strategic plans are the key to
ensuring the achievement of agency-wide objectives.
---------------------------------------------------------------------------
\2\ See OMB Circular No. A-11, Part 2 and GAO, Executive Guide:
Effectively Implementing the Government Performance and Results Act,
GAO/GGD-96-119, June 1996.
---------------------------------------------------------------------------
In its Executive Guide, GAO cites the following practices as
critical to successful strategic planning:
Stakeholder involvement, including Congress and the
Administration, state and local governments, third-party providers,
interest groups, agency employees, fee-paying customers, and the
public;
Assessment of the internal and external environment
continuously and systematically to anticipate future challenges and
make future adjustments so that potential problems do not become
crises; and
Alignment of activities, core processes, and resources to
support mission-related outcomes.
Successful strategic planning practices:
Present a comprehensive mission statement.
Establish long-term goals for all major functions and
operations.
Identify approaches and strategies to achieve the goals
and objectives and obtain the various resources needed.
Document the relationship between long-term goals/
objectives and annual performance goals.
Identify key factors external to the agency and beyond its
control that could significantly affect achievement of the strategic
goals.
Describe how program evaluations have been used to
establish or revise strategic goals, and a schedule of future program
evaluations.
Strategic plans are important, but it is necessary for departments
and agencies to be able to make ongoing adjustments. As a military
strategist once noted: ``No battle plan survives contact with the
enemy.'' It is important for planning to be fluid and flexible enough
to respond to an evolving environment and given the history of veterans
programs, it would be surprising if there wasn't some important
development that fundamentally impacted the veterans claims processing
world.
Leadership plays an even more important role in bringing about
fundamental change than the strategic plan. There are some well
established principles for leading change management including:
Ensuring top leadership drives the transformation. Strong
and inspirational leaders are indispensible in any organization,
especially those organizations undergoing large-scale transformations.
Establishing a clear vision and integrated strategic
transformation goals. Successful transformations depend on developing
and continuously communicating the overarching vision and strategic
goals of the future state organization.
Redesigning organizational structures, if necessary, to
enable the vision. Wholesale change requires a careful examination of
organizational structure and processes to determine if these need to be
revised to facilitate this transformation.
Creating a sense of urgency, implement a timeline, and
show progress from Day One. Change management thought leaders agree
that a primary driver of a successful transformation effort is
identifying a high-level of urgency throughout the organization.
Charting the course with a clearly-defined timeline and
details of the progress are essential for supporting the change
initiative and instilling buy-in throughout the affected stakeholder
community.
Communicating frequently through multiple channels to
multiple stakeholders. Successful change initiatives are driven by a
comprehensive, consistent communication strategy that strives for both
understanding and buy-in.
Dedicating a powerful implementation guidance team to
manage the transformation process. Large-scale change does not happen
without a powerful guiding force and a fragmented management team
cannot do the job.
Engaging employees to seek their improvement ideas, build
momentum, and gain ownership for the transformation. Successful
transformations involve employees from the beginning to gain their
ownership for the changes occurring in the organization.
Sustaining the effort. A successful organizational
transformation requires the adoption of a new culture and changes will
be permanent only if employees are able and willing to embrace a new
set of values and norms.
While the Academy has not systematically reviewed VBA's current
change management efforts, a review of the literature produced by the
Agency as well as reports and studies suggest that the leadership is
well-versed in these concepts and is, in fact, following many of the
principles noted above. It is also apparent that VBA leaders both in
Headquarters and in the field are working hard to bring about the
transformation. The breadth and scope of what is underway is massive.
There are, however, a number of cautionary notes that are offered for
consideration regarding the transformation process underway:
The Agency does not appear to have much, if any, surge
capacity--that is, the ability to bring additional resources to bear if
an exigent circumstance arises that impacts workloads. This can be
discerned from reviewing GAO and VAOIG studies as well as looking at
VBA's published performance reports. It is not clear what will happen
if there is some ``seismic shock'' to the workload akin to what
happened with the Veterans Claims Assistance Act of 2000 or the
``Nehmer'' cases VBA recently completed or even small but significant
shocks.
Technological advances are the key to VBA's future. It is
likely that VBA's future, in terms of the increasing complexity of
claims, is likely to resemble its past. In these times of budget
austerity, the only way to ensure that you have the capability to deal
with growing or changing workload will be to have the electronic tools
that not only make the work faster and more accurate but also allow for
more organizational agility in terms or adapting to the ever-evolving
environment. Having digital claims records, using rule-based claims
development and processing tools and communicating and exchanging
information with key claims information providers will transform the
operation.
Technological changes being implemented not only have
enormous potential to make claims processing better in the long run,
but also have an even greater chance of making claims processing more
difficult in the short run. This is practically a truism for large-
scale information technology initiatives, and VBA would hardly be the
first Federal agency to face this situation. Whether due to staff
downtime to learn new processes, insufficiently tested software, poor
interfacing between the new technology and the old processes or any
number of other ``glitches,'' there is always an excellent chance that
the new systems do not, in the short run, live up to expectations. Some
of the development difficulties with VBMS are testimony to that.
Implementing large-scale change during periods of high
workload volumes is always a careful dance involving moving ahead with
planned changes while simultaneously trying to not seriously disrupt
workflow. This can be a dilemma for any leader but given the extreme
amount of work in the pipeline and the comprehensiveness of their
planned changes, it is particularly challenging for VBA. It is
important during such times to have good communications with the people
implementing these changes--the field staff in regional offices, both
leaders as well as rank and file staff. It is also important to take
the time to assess and reassess the actual impacts of the changes in
real time and to also determine the cumulative impacts of the changes.
Keeping the focus on the quality of the claims
decisionmaking process is critical. When workloads remain high and
major new processing changes are implemented, the emphasis often moves
to meeting production goals, sometimes at the sacrifice of quality. VBA
leaders have high goals set for quality but as workload continues to
remain high, they will have to be vigilant to make sure this does not
lead to declines in quality.
The performance targets set for 2015--elimination of the
700,000 claims backlog and making decisions at a 98% accuracy rate--are
indeed stretch goals. In order to accomplish them, every initiative
will have to have worked precisely as planned. To make this happen, VBA
will have to work extremely hard, avoid any serious changes to the
claims processing environment and have the support of all the
stakeholders in this room today--Congress, the Administration, VSOs,
and other elements of VA.
VBA's greatest strengths are its people and its mission. The
benefits programs VBA administers were signed into law by presidents
Washington, Madison, Lincoln, Wilson and Franklin Roosevelt. For over
two centuries, these programs have succeeded in transitioning
generations of warriors successfully back into civilian society and VA
leaders should take every opportunity to remind employees of the
Agency's rich history. They also need to remind staff that people who
come to VBA for help are dealing with some of the most significant
events in life: disability, illness, death, buying a home and going to
school. The actions of VBA employees make a critical difference in the
lives of these veterans and their families. This is no less true today
than it was 200 years ago. An ongoing and consistent message to
reinforce that fact can be an important driver for bringing about
transformational change.
Mr. Chairman, that concludes my written statement, and I would be
pleased to answer any questions you or the Committee members may have.
Chairman Sanders. Thank you very much, Mr. Thompson.
Mr. Stichman.
STATEMENT OF BART STICHMAN, JOINT EXECUTIVE DIRECTOR, NATIONAL
VETERANS LEGAL SERVICES PROGRAM
Mr. Stichman. Thank you, Mr. Chairman, Ranking Member Burr
and Members of the Committee. Thank you for the opportunity to
present the views of the National Veterans Legal Services
Program, a VSO, on the VA's efforts in addressing the claims
required to be adjudicated under the order of the U.S. District
Court in Nehmer versus U.S. Department of Veterans Affairs.
As background, Nehmer is a class action lawsuit that was
initiated by NVLSP in 1986 on behalf of Vietnam veterans and
their survivors.
The lawsuit challenged a VA regulation that provided that
chloracne, a skin condition, is the only disease that has a
positive association with exposure to Agent Orange.
It is important to understand that the requirement in the
Nehmer consent decree to re-decide past claims denials is only
triggered if and when the VA Secretary decides that the
scientific evidence now shows that a positive relationship
exists between Agent Orange exposure and a disease whose
positive relationship with Agent Orange had not previously been
recognized by VA.
So, it was in 2010 when Secretary Shinseki was
simultaneously faced with, one, a growing backlog of VA claims
and, two, the conclusion of the National Academy of Sciences in
its latest report under the Agent Orange Act of 1991 to place
three new diseases, ischemic heart disease, Parkinson's
disease, and chronic B-cell leukemia in the same category of
association with Agent Orange exposure as all of the other
diseases that prior VA Secretaries had concluded should be
afforded presumptive service-connected status due to their
association with Agent Orange.
Secretary Shinseki knew that, if he agreed as a result of
the latest NAS report to add these three new diseases to the
list of diseases already accorded presumptive service
connection, VA adjudicators would be required by the Nehmer
consent decree to re-decide more than 150,000 past claims and
tens of thousands of new claims for these three diseases at the
exact same time that the same adjudicators were faced with the
growing backlog of other claims.
But in a courageous decision that gave appropriate
recognition of both the scientific evidence and the service and
needs of disabled Vietnam veterans who risked harm to
themselves in serving their country in Vietnam, Secretary
Shinseki agreed in August 2010 to add these three diseases as
presumptively service-connected due to Agent Orange exposure.
In the years prior to the administration of Secretary
Shinseki, VA efforts to implement the Nehmer consent decree
were shoddy. Things changed under Secretary Shinseki.
The VA ensured that the 150,000 past claims for these three
diseases were decided speedily and accurately. He accomplished
this through two key management decisions.
First, he wisely assigned decisionmaking on these 150,000
past claims and 60,000 new claims to a large group of VA
adjudicators whose primary task was devoted to these claims.
Second, he assembled a competent management team to train
these adjudicators through use of a 130-page training guide and
a training video. The end result was speedy and quality
decisionmaking.
On October 30, 2010, 2 months after the decision to add the
three diseases, VA began to adjudicate these past claims and
they adjudicated 146,000 of these claims by August 1, 2012, in
an accurate and timely fashion I am happy to report.
I did want to bring one of the veterans who got one of
these decisions with me but we were unable to get him to come
due to transportation problems. He is confined to a wheelchair
but he authorized me to tell you about his re-adjudication by
the VA.
He has coronary artery disease which was first diagnosed
when he was 39 years old in 1987. He served in the Army from
1966 to 1968 including a 6-month tour in Vietnam and his
original claim was denied because coronary artery disease was
not recognized at that time.
In a nine-page letter he received and a 19-page rating
decision which I have here, he not only was given an earlier
effective date and a grant of service connection for coronary
artery disease back to 1989 but, while the VA was reviewing his
claims file, they found a number of past errors that they
rectified.
In the same decision, they gave him an earlier effective
date for his grant of service connection for diabetes mellitus
which is another Agent Orange related disease back to 1991; an
earlier effective date for the grant of special monthly
compensation based on housebound status back to 1991; an
earlier effective date for service connection for erectile
dysfunction retroactive to 2004; an earlier effective date for
special monthly compensation based on loss of use of a creative
organ back to 2004; and an earlier effective date for service
connection for an eye disease related to diabetes retroactive
to 2002.
Chairman Sanders. Mr. Stichman, if you could come to a
conclusion.
Mr. Stichman. This shows the quality of the decisionmaking
that the VA made during this period. Thank you.
[The prepared statement of Mr. Stichman follows:]
Prepared Statement of Barton F. Stichman, Joint Executive Director,
National Veterans Legal Services Program
Mr. Chairman and Members of the Committee: Thank you for the
opportunity to present the views of the National Veterans Legal
Services Program (NVLSP) on VA's efforts in addressing the claims
required to be adjudicated under the order of the U.S. District Court
of the Northern District of California in Nehmer v. U.S. Department of
Veterans Affairs, as well as our assessment of VA's transformation
efforts aimed at improving the timeliness and accuracy of claims
decisions.
secretary shinseki's appropriate decision in 2010 under
the agent orange act of 1991
As background, Nehmer v. U.S. Department of Veterans Affairs is a
class action lawsuit that was initiated by NVLSP's attorneys in 1986 on
behalf of Vietnam veterans and their survivors. The lawsuit challenged
a VA regulation, former 38 CFR 3.311a, that provided that chloracne, a
skin condition, is the only disease that has a positive association
with exposure to Agent Orange or the other herbicides containing dioxin
that was used by the United States in Vietnam. In 1989, the district
court invalidated this regulation and voided all VA decisions denying
benefit claims under the regulation. The VA decided to comply, rather
than appeal this decision.
In 1991, NVLSP's attorneys negotiated a favorable consent decree
with the VA in Nehmer. The Nehmer consent decree requires VA, whenever
it recognizes in the future that the scientific evidence shows that a
positive relationship exists between Agent Orange exposure and a new
disease, to (a) identify all claims based on the newly recognized
disease that were previously denied and then (b) pay disability and
death benefits to these claimants, retroactive to the initial date of
claim. Between 1991 and 2009, VA has recognized that scientific studies
show that there is a positive association between Agent Orange exposure
and diabetes, and more than a dozen different types of cancer.
In assessing VA's transformation efforts in improving claims
processing under the tenure of Secretary Shinseki, it is important to
understand that the requirement in the Nehmer consent decree to
redecide past claims denials is only triggered if and when the VA
Secretary decides that the scientific evidence now shows that a
positive relationship exists between Agent Orange exposure and a
disease whose positive relationship with Agent Orange had not been
previously recognized by VA.
So it was in 2010, when Secretary Shinseki was simultaneously faced
with (a) a growing backlog of VA claims, due in part to the increasing
number of claims being filed by veterans returning from Iraq and
Afghanistan, and (b) the conclusion of the National Academy of Sciences
(NAS) in its latest report under the Agent Orange Act of 1991 to place
three new diseases--ischemic heart disease, Parkinson's disease, and
chronic B-cell leukemia--in the same category of association with Agent
Orange exposure as all of the diseases that prior VA Secretaries had
concluded should be accorded presumptive service-connected status due
to their association with Agent Orange.
Secretary Shinseki knew that if he agreed as a result of the latest
NAS report to add these three new diseases to the list of diseases
already accorded presumptive service-connected status due to Agent
Orange exposure, VA adjudicators would be required by the Nehmer
consent decree to redecide more than 150,000 past claims for these
three diseases--at the exact same time that these same adjudicators
were faced with the growing backlog of other claims. He could have
avoided the need to redecide these 150,000 past claims by simply
refusing to add the three diseases as related to Agent Orange exposure.
But in a courageous decision that gave appropriate recognition to both
the scientific evidence and the service and needs of hundreds of
thousands of disabled Vietnam veterans who risked harm to themselves in
serving their country in Vietnam, Secretary Shinseki agreed on
August 31, 2010 to add these three diseases as presumptively service-
connected due to Agent Orange exposure.
va's efforts in addressing nehmer claims
In the years prior to the administration of Secretary Shinseki,
VA's efforts to implement the Nehmer consent decree were shoddy. On
several occasions, NVLSP's attorneys had to file a motion to enforce
the consent decree due to VA failure to comply with the terms of the
consent decree. On each of these occasions, the U.S. District Court or
the U.S. Court of Appeals for the Ninth Circuit ruled against the VA.
VA's performance was so bad that the U.S. District Court had to issue
an order requiring VA to show cause why it should not be held in
contempt.
Things changed under Secretary Shinseki. The Secretary ensured that
the 150,000 past claims for ischemic heart disease, Parkinson's
disease, and chronic B-cell leukemia were decided speedily and
accurately. He accomplished this result through two key management
decisions. First, he wisely assigned decisionmaking on these 150,000
past claims to a large group of VA adjudicators whose primary task was
devoted to these claims. Second, he assembled a competent management
team to train these adjudicators thoroughly through use of a more than
130-page training guide and a training video.
The end result was speedy and quality decisionmaking. On
October 30, 2010, two months after Secretary Shinseki's issued the VA
rule adding the three diseases as Agent Orange-related, VA began to
issue decisions on these past claims. The VA adjudicated over 146,000
of these claims by August 1, 2012.
Not all of these adjudications were correct. As class counsel,
NVLSP has a team of attorneys and paralegals devoted to ensuring that
VA meets its obligations under the Nehmer consent decree. VA provides
NVLSP with a copy of all of its decisions under the Nehmer consent
decree. NVLSP's attorneys work with the Vietnam veterans and survivors
on these cases to ensure that the VA assigns them the correct effective
date for their award of benefits for these three diseases and pays them
the proper amount of retroactive compensation. NVLSP and VA have
developed an effective system for quickly rectifying mistakes in
decisionmaking, and thus far nearly 1,000 mistakes have been corrected.
But the mistakes have been relatively rare, and a far cry from the low
quality of decisionmaking that occurred during prior administrations.
NVLSP has also identified a group of more than 60,000 past
claimants whom VA did not previously identify as needing review under
the Nehmer consent decree. But to VA's credit, it has agreed that these
cases need to be reviewed, and the parties are currently working
together to ensure that they are reviewed in a timely fashion.
While VA has been subject to much criticism over the past few years
about the timeliness and accuracy of its decisionmaking in general, the
bottom line is that on Nehmer claims, VA deserves a great deal of
credit.
va's other transformation efforts for improving timeliness and accuracy
NVLSP has three observations about other VA's transformation
efforts aimed at improving the timeliness and accuracy of claims
decisions. First, we commend VA management's development of the new
Fully Developed Claim (FDC) process. While it needs to be clarified and
modified for it to produce significant improvement in timeliness and
accuracy, it is a welcome innovation.
In its present formulation, it is not applicable to many claims
because VA prohibits use of FDC process if the claimant has any other
claims pending that are not subject to the FDC process. This is unwise.
For example, claimants and their representatives are being deterred
from using the FDC process because it requires that they withhold the
filing of other claims--and risk loss of months of benefits--simply to
obtain a quick decision on one claim filed under the FDC process.
Second, there has long been an unfortunate obsession by both VA and
Congress with one statistic: how long it takes VA to decide an initial
claim for benefits, regardless of the quality of the decision on that
claim. When VA reports to Congress that the average time it takes to
decide an initial claim is now down to 164 (or whatever number of)
days, it is not representing to Congress that this is the number of
days it takes on average to decide an initial claim correctly. Rather,
VA is merely reporting the average time it takes to reach a correct or
incorrect decision. The long-standing obsession with this skewed
statistic has long produced a significant deleterious effect: VA
regional office adjudicators prematurely decide claims--without taking
the time to obtain and assemble the evidence necessary to properly
decide a claim--in an effort to ensure that the average time for
deciding an initial claim that is reported to VA managers and Congress
is a low number of days. This obsession is counter-productive because
it produces unjust premature denials, which, in turn, result either in
the veteran giving up on a potentially valid claim or in appeals filed
by veterans which create the existing backlog of claims.
Finally, on cases in which an appeal is filed, there is another
longstanding adjudicatory phenomenon which both frustrates the
interests of justice and adds to the backlog. NVLSP and others have
long observed that after a veteran files an appeal (i.e., a notice of
disagreement) with an initial decision, there is an unfortunate
tendency of many VA adjudicators to overdevelop the claim. That is,
there is a tendency by many VA regional office and Board of Veterans'
Appeals adjudicators to delay a decision on a claim where the evidence
in the current record supports a grant of the claim, in order to obtain
additional evidence--typically in the form of another VA medical
examination--in the apparent hope that evidence will be developed to
support a denial of the claim. This longstanding phenomenon certainly
works to protect the public fisc. But it is contrary to the pro-
claimant process embodied in statutes and regulations and is a major
contributor to the large VA backlog of claims.
I would be pleased to answer any questions that Members of the
Committee may have.
Chairman Sanders. Thank you very much.
Mr. Violante.
STATEMENT OF JOSEPH VIOLANTE, NATIONAL LEGISLATIVE DIRECTOR,
DISABLED AMERICAN VETERANS
Mr. Violante. Mr. Chairman and Members of the Committee,
thank you for inviting Disabled American Veterans to testify
about the Veterans Benefits Administration's claims processing
transformation.
Congratulations, Chairman Sanders, for being selected to
lead this Committee, and welcome back Ranking Member Burr. I
look forward to working with both of you and all the Members of
this Committee.
Mr. Chairman, the timely and accurate award of a disability
rating does more than provide compensation. It provides an
array of benefits that support the recovery and transition of
veterans and families and survivors.
But when benefits are delayed or denied, the consequences
can be devastating. Today, the number of claims pending is far
too high. The time veterans wait is too long, and the accuracy
of decisions is too low.
But while there is a tendency to focus only on reducing the
backlog, DAV continues to urge VBA and Congress to concentrate
their efforts on the underlying problems that created and
continue to fuel the backlog.
Three years ago, VBA set out on an ambitious path to
completely transform its IT systems, business processes, and
corporate culture while simultaneously continuing to process
more than one million claims annually.
In the midst of this transformation, it is hard to get the
proper perspective to measure whether the final design will
ultimately be successful.
For anyone who has lived through a home renovation, that
experience would have many parallels. It is hard to judge
whether the renovation will be successful when you are
surrounded by open walls, exposed wires and pipes, as
unexpected problems pop up adding time and cost to the project.
In a similar way, observations of VBA's transformation
efforts logically focus on the exposed errors and unfinished
initiatives but it is still too soon to judge whether the
transformation will be successful. Of course, it would be
equally premature to simply trust that they will succeed.
DAV believes that VBA is on the right path with the right
goals and that they have leadership committed to transforming
and institutionalizing a new claims system that will better
serve veterans.
Ultimately, the question of whether they will be successful
remains to be determined, but one point we are certain of,
there is no turning back. VBA is currently rolling out the
Veterans Benefits Management System, its new IT program for
processing claims.
Although not yet fully developed or deployed, there has
been some extremely important milestones. One of the most
critical was the decision and commitment to scan all legacy
paper files for new or reopened claims requiring rating-related
actions. The creation of the digital eFolders allows
instantaneous transmission and simultaneous review of files,
saving both time and resources.
The most important process achievement is the
implementation of VBA's new transformation organizational model
which creates cross-functional teams working in segmented lanes
to more efficiently processing claims.
Another key reform was the creation of local Quality Review
Teams that monitor claims processing in real time to catch and
correct errors before the decision is finalized.
Finally, one of the most encouraging aspects has been the
open, transparent, and collaborative manner in which they work
with DAV and other VSOs. Under Secretary Hickey has
demonstrated her commitment to expanding the partnership with
VSOs and we believe that veterans are better served thanks to
her strong and principled leadership.
Mr. Chairman, DAV believes significant progress has been
made but important work remains. DAV offers numerous
recommendations in our testimony, but let me highlight just a
few.
First, while aggressive oversight of VBA claims
transformation efforts is essential, Congress must support and
fully fund the completion of VBMS and all document scanning. We
also recommend an independent review of VBMS by outside IT
experts.
Second, VBA must develop a new corporate culture based on
quality, accuracy, and accountability throughout every regional
office.
Finally, Congress should enact legislation to mandate that
VBA shall accept private medical evidence when it is competent,
credible, and adequate for rating purposes.
In addition, private physicians should be allowed access to
DBQs for medical opinions of service connection and for PTSD
diagnosis.
Mr. Chairman, that concludes my testimony. I will be happy
to answer any questions.
[The prepared statement of Mr. Violante follows:]
Prepared Statement of Joseph A. Violante, Director,
DAV National Legislative
Mr. Chairman and Members of the Committee: Thank you for inviting
DAV (Disabled American Veterans) to testify about the status of the
Veterans Benefits Administration's (VBA's) claims processing
transformation efforts.
Mr. Chairman, the timely delivery of earned benefits to the
millions of men and women who have served in our Armed Forces is one of
the most sacred obligations of the Federal Government. The award of a
service-connected disability rating does more than provide compensation
payments; it is the gateway to an array of benefits that support the
recovery and transition of veterans, their families and survivors.
However, when these benefits are delayed or unjustly denied, the
consequences to veterans and their families can be devastating. For
those wounded heroes who file claims for disability compensation, the
wait to receive an accurate rating decision and award can take anywhere
from a few months to several years; longer if they have to appeal
incorrect decisions. For that reason, we are grateful that this
Committee's first regular hearing of the 113th Congress focuses on one
of DAV's highest priorities: completing the reform of the veterans
benefits claims processing system.
As the Nation's leading veterans service organization (VSO)
assisting veterans seeking disability compensation and other benefits,
DAV has tremendous experience and expertise relating to the processing
of claims. With a corps of 260 full-time professional National Service
Officers (NSOs) and 35 Transition Service Officers, DAV assists almost
a quarter of all veterans who file claims for disability compensation
each year. Last year, DAV NSOs reviewed more than 326,000 claims files,
filed 234,500 new claims for benefits, and participated in more than
287,000 rating board actions. In this capacity, we assist VBA in its
work by helping veterans file more complete and accurate claims. From
our decades of experience working on veterans claims, we fully
understand both the magnitude and complexity of the challenges VBA
faces in trying to accurately adjudicate more than a million claims
each year in a timely manner, and we remain committed to doing all we
can to help develop and implement solutions.
Mr. Chairman, there will be much discussion today about the size of
the pending backlog of claims, nationally as well as in individual
states and cities, and understandably so. Today there are about 900,000
claims for compensation and pension awaiting decisions at VBA, more
than double the number pending four years ago. Of those claims, fully
70 percent have been waiting more than 125 days, VBA's official target
for measuring the backlog, which is double the number of just two years
ago. Moreover, the length of time it takes to process veterans' claims
also continues to rise, with the average processing time now almost 280
days, far from VBA's target of 80 days. Several Regional Offices (ROs)
are averaging more than a year to process claims. New York takes almost
450 days on average and the Los Angeles RO averages over 500 days.
Looking at these numbers, it is clear that the challenges facing VBA
are enormous.
But while there can be a tendency in the media to talk only about
reducing the backlog, we continue to argue that VBA and Congress must
instead concentrate their efforts on addressing the underlying problems
that created and continue to fuel the backlog. After all, VBA could
eliminate the backlog quite easily by simply denying all pending
claims, or granting every claim, but neither approach would be correct
and neither would help to resolve the systemic problems that created
the backlog in the first place.
As we have said many times in the past, and it bears repeating
today, the backlog is a symptom, not the cause of VBA's claims
processing problems. It is similar to a person suffering from a cold,
virus or flu who may have severe and painful symptoms, such as a high
temperature or body aches. Treating those symptoms alone will do little
to rid the body of the underlying illness or to prevent those same
symptoms from recurring in the future. Similarly, VBA could direct all
existing and new resources to processing claims using old technologies
and processes, and perhaps that would more quickly reduce the existing
backlog in the short term. But such an approach would do little to
build the modern, paperless system necessary for timely and accurate
processing of veterans claims in the future, and as certain as the
tide, the backlog would roll back in and rise again.
Mr. Chairman, in many ways, VBA today faces the same core problems
that have plagued them for decades: too many claims being processed and
adjudicated inaccurately without sufficient accountability for the
results, rather than a system designed to decide each claim right the
first time. The solution to these problems will require new
technologies and business processes, and most importantly, a cultural
transformation built upon the foundations of quality, accuracy and
accountability. From our vantage point as participants in and observers
of the VBA claims system, as well as active collaborators in the
current transformation process, we believe today's VBA leadership
shares our vision.
In early 2010, Secretary Shinseki laid out an extremely ambitious
goal for VBA to achieve by 2015: process 100 percent of claims in less
than 125 days, and do so with 98 percent accuracy. However, if the only
information available was the latest metrics from VBA's ASPIRE
Dashboard, one would be hard pressed to find any signs of progress
toward achieving the Secretary's goals. But numbers alone do not tell
the whole story.
As you know, VBA set out on a path three years ago to completely
transform their IT systems, business processes and corporate culture,
while simultaneously continuing to process more than a million claims
each year. Today, VBA is actively rolling out new organizational models
and practices, and continuing to develop and deploy new technologies
almost daily. In the midst of this massive transformation, it is hard
to get the proper perspective to measure whether their final design
will be successful. But for anyone who has ever lived through a major
home renovation, or seen a home makeover show on television, that
experience would have many parallels to what VBA is experiencing during
its transformation. During the renovation, the homeowner would have to
live through the mess and chaos of contractors demolishing walls,
ripping out pipes and tearing up floors, making living there much more
difficult during this process. And even though the homeowner knows what
the finished renovation is supposed to look like and how it will
improve their home, it is hard to judge whether the renovation will be
successful when they can observe nothing but open walls, exposed wires,
and unexpected problems arising that add time and cost to the
renovation.
In a similar way, current observations of VBA's transformation
efforts logically focus on the openly exposed flaws, problems and
unfinished initiatives, but it would be premature to conclude that this
imperfect and uncompleted transformation process is a precursor to a
flawed final outcome. It would be equally premature to sit back and
simply trust that the final result will be successful based on nothing
more than plans and promises. Instead we must all remain actively
engaged in overseeing and supporting VBA to achieve the results we all
desire.
milestones of progress
Mr. Chairman, taking all of the above into consideration, DAV
believes that VBA is on the right path, that they have set the right
goals and that they have leadership committed to transforming and
institutionalizing a new claims processing system to better serve
veterans. How successful the current transformation efforts will
ultimately be remains an open question to be answered at a later time,
and on that point there can and will be differing opinions. However, we
hope that following today's hearing there is no disagreement on one
point: there can be no turning back. VBA must complete this essential
transformation from its outdated, paper-based claims system to a
modern, paperless, automated claims system. The stakes for veterans and
the investment by VA are high, so failure is not an option.
Recognizing that its old system was irretrievably broken, in 2009
VBA launched dozens of new ideas, initiatives and pilots grouped in
three categories: people, processes and technology. Having thoroughly
tested, validated and synthesized the best practices culled from all of
this experimentation, VBA is currently rolling out many of these new
programs nationally. The biggest and most important amongst these is
the Veterans Benefits Management System (VBMS), the new IT
infrastructure for claims processing. Over the past year, VBMS has been
rolled out to 20 Regional Offices, and will be fully deployed to all
remaining ROs before the end of the year, possibly as soon as June. It
is important to remember that VBMS is not yet a finished product;
rather it continues to be developed and perfected as it is deployed so
it is hard to judge whether the final system will deliver all of the
functionality and efficiency required to meet VBA's future claims
processing needs. However, there have been a number of extremely
important milestones that are themselves significant signs of progress.
In our view, probably the most crucial milestone was VBA's decision
to scan all paper claims files for every new or reopened claim
requiring a rating-related action. This decision embodied VBA's total
commitment to creating a fully digital, paperless, automated claims
processing system, which DAV and other VSOs had strongly encouraged for
years. Although this will require significant upfront investment to
cover the costs of scanning tens of millions of paper records, in the
long run it will pay dividends for both VBA and veterans.
Another important milestone is the creation of digital e-folders,
which serve as the cornerstone of the new VBMS system. E-folders
facilitate instantaneous transmission and simultaneous reviewing of
claims files. Every new or reopened rating-related claim made at an RO
that has adopted VBMS will now have an e-folder created and all
supporting documentation will be scanned and reside in that e-folder.
For claims that were already in process at the time of conversion to
VBMS, those claims will be developed using legacy systems, but will be
rated inside VBMS with an e-folder, but supporting documentation will
continue to reside inside a traditional paper claims folder. At
present, there are an estimated 200,000 e-folders and that number will
continue to grow as the remaining ROs convert to VBMS this year. In
addition, the Appeals Management Center (AMC) is now working in VBMS
and able to review e-folders. The Board of Veterans Appeals (BVA) will
also begin receiving appeals in VBMS on a pilot basis this month.
DAV has been closely involved in advising the VBMS team throughout
its development and has confidence in their strategic plan; however, it
would be a mistake to simply trust that the finished product will do
the job as intended. Similar to a home renovation, there is a need to
have qualified, independent experts review plans and inspect progress
at regular intervals. Although a homeowner may know where they want
electrical outlets located, it is unlikely that they would be qualified
to judge whether the electrical wiring schematic and supplies are safe
or sufficient to handle the intended load. In a similar manner, while
we believe VBA's plans for VBMS contain the necessary features and
functions, we do not have the technical expertise to determine whether
the enterprise architecture and iterative development process will
ultimately result in a successful IT system. For this reason, DAV
continues to recommend that VBA bring in an independent panel of IT
experts to review the plans and progress of VBMS. Such a team could be
composed of leading IT experts from companies such as Google, Apple,
and Amazon, who would volunteer a day or two to help evaluate whether
VBMS is likely to achieve its intended purpose, or whether there are
significant concerns that merit further scrutiny or corrective actions.
Other key technological developments supporting paperless claims
processing include e-Benefits and the Stakeholder Enterprise Portal
(SEP), which allow veterans and their representatives to file claims,
upload supporting evidence and check on the status of pending claims.
More than 2,000 claims have been initiated via e-Benefits through its
VONAPPS Direct Connect (VDC) application and just last month, DAV was
able to file the first SEP claim on behalf of a veteran for whom we
hold power-of-attorney (POA), which is now being processed inside VBMS
for a truly end-to-end digital claim.
In terms of business processes milestones, VBA has fully rolled out
its new transformation organizational model (TOM) to every Regional
Office. Based on the best practices from their pilots and initiatives,
this new organizational model is centered on two major changes in how
ROs manage their work. The traditional triage function is now done
through an Intake Processing Center (IPC) at every RO, which places
more experienced employees at the front end of the process in order to
better direct claims along several new segmented processing lanes. The
smaller, less complex claims will be processed in the ``express lane,''
the most complex claims will be done in the ``special ops'' lane, and
the bulk of the claims will be done in the ``core'' lanes. In each of
these segmented lanes, cross-functional teams of Veterans Service
Representatives (VSRs) and Rating Veterans Service Representatives
(RVSRs) work together on claims, allowing greater interaction
throughout the process, and are expected to yield greater accuracy and
timeliness. This new organizational model also allows each RO to better
align its workforce according to experience and expertise levels. Other
key process improvements that DAV strongly supports include the Fully
Developed Claims (FDC) program, which expedites ready-to-rate claims,
and Disability Benefits Questionnaires (DBQs), which standardize and
encourage the collection of private medical evidence to aid in rating
decisions.
On the people side of its transformation efforts, VBA has also
initiated vitally important changes that should yield positive long-
term improvements. DAV was especially pleased that VBA fulfilled one of
our longstanding recommendations through the creation of local Quality
Review Teams (QRTs), whose primary function is to monitor claims
processing in real time to catch and correct errors before rating
decisions are finalized. The QRTs have been trained by the national
STAR (Systematic Technical Accuracy Review) quality assurance staff to
provide consistent application of VBA rules and regulations. QRTs are
also helping to develop and implement training and mentoring programs
in many ROs, providing a much-needed emphasis on quality and accuracy,
rather than just speed and production. The decision to move 600 VSRs
and RVSRs out of day-to-day production and into QRT positions is a
powerful sign of VBA's commitment to creating a culture of quality.
Finally, one of the most important and encouraging aspects of VBA's
transformation efforts has been the open, transparent and collaborative
manner in which they have worked with stakeholders, particularly with
VSOs. From the outset of this transformation, VBA leaders reached out
to DAV and other VSOs seeking our ideas and support to help fix the
broken claims system. Throughout the development of VBMS, SEP, TOM,
FDC, DBQs and many other small and large initiatives, VSOs have been
regularly invited to share our perspectives and ideas. Since being
confirmed, Under Secretary Allison Hickey has repeatedly demonstrated
her passionate commitment to expanding the partnership between VBA and
VSOs, and we believe that veterans will be better served thanks to her
strong and principled leadership.
recommendations
Mr. Chairman, DAV believes that significant progress has been made,
but that vitally important work remains. In order to support VBA's
transformation efforts and further improve the delivery of benefits to
veterans, DAV makes the following recommendations.
First, Congress must continue to perform aggressive oversight of VBA's
ongoing claims transformation efforts, particularly new IT
programs, while actively supporting the completion and full
implementation of these vital initiatives.
In order for VBA's current transformation plans to have any
reasonable chance of success, VBA must be allowed to complete and fully
implement them. It is imperative that Congress continue to support this
goal, even while continuing to perform aggressive oversight. In
particular, we recommend that Congress encourage an independent, expert
review of VBMS. At the same time, Congress must continue to fully fund
the completion of VBMS, including providing sufficient funding for
digital scanning and conversion of legacy paper files, as well as the
development of new automation components for VBMS. As stated earlier,
it is too late to turn back from paperless processing and we urge
Congress to both oversee and support full funding for this and other
vital IT initiatives throughout the final development and
implementation phases.
Second, Congress must encourage and support VBA's efforts to develop a
new corporate culture based on quality, accuracy and
accountability, as well as strengthen the transmission and
adoption of these values and appropriate supportive policies
throughout all VBA Regional Offices.
The long-term success of all of VBA's transformation efforts will
depend on the degree to which these changes are institutionalized and
disseminated from the national level to the local level. In addition to
training, testing and quality control, the best means of transforming
and transmitting cultural change is to properly align measuring and
reporting functions with desired goals and outcomes for both VBA
leadership and employees. For example, as long as the most widely
reported metric of VBA's success is the Monday Morning Workload
Reports, particularly the weekly update on the size of the backlog,
there will remain tremendous pressure throughout VBA to place
production gains ahead of quality and accuracy. Similarly, if
individual employee performance standards set unrealistic production
goals, or fail to properly credit ancillary activity that contributes
to quality but not production, those employees will be incentivized to
focus on activities that maximize production. VBA must develop more and
better measures of work performance that focus on quality and accuracy,
both for the agency as a whole and for individual employees.
Furthermore, VBA must ensure that employee performance standards are
based on accurate measures of the time it takes to properly perform
their jobs.
Finally, Congress must ensure that VBA does not change its
reporting or metrics for the sole purpose of achieving statistical
gains, commonly referred to as ``gaming the system,'' in the absence of
actual improvements to the system. For example, VBA recently changed
how processing errors are scored for multi-issue claims. Previously, a
claim would be considered to have an error if one mistake on at least
one issue in the claim was detected during a STAR review. Under the new
error policy, if there are 10 issues in the claim and a single error is
found on one of the issues, that would now be scored as only 0.1 error
for that claim. While this may be a more valid way of measuring
technical accuracy, it also has the effect of lowering the error rate,
thereby implying an improvement in quality, even though the same number
of errors was detected.
Third, Congress and VBA should enact and adopt new legislation and
policies that maximize the use of private medical evidence to
conserve VBA resources and enable quicker, more accurate rating
decisions for veterans.
DAV and other VSOs have long encouraged VBA to make greater use of
private medical evidence when making claims decisions, which would save
veterans time and VBA the cost of unnecessary examinations. DBQs, many
of which were developed in consultation with DAV and other VSO experts,
have been designed to allow private physicians to submit medical
evidence on behalf of veterans they treat in a format that aids rating
specialists. However, we continue to receive credible reports from
across the country that many VSRs and RVSRs do not accept the adequacy
of DBQs submitted by private physicians, resulting in redundant VA
medical examinations being ordered and valid evidence supporting
veterans' claims being rejected.
Although there are currently 81 approved DBQs, VBA has only
released 71 of them to the public for use by private physicians. In
particular, VBA should allow private treating physicians to complete
DBQs for medical opinions about whether injuries and disabilities are
service-connected, as well as DBQs for PTSD, which current VBA rules do
not allow; only VA physicians can make PTSD diagnoses for compensation
claims. Congress should work with VBA to make both of these DBQs
available to private physicians.
To further encourage the use of private medical evidence, Congress
should amend title 38, United States Code, section 5103A(d)(1) to
provide that, when a claimant submits private medical evidence,
including a private medical opinion, that is competent, credible,
probative, and otherwise adequate for rating purposes, the Secretary
shall not request a VA medical examination. This legislative change
would require VSRs and RVSRs to first document that private medical
evidence was inadequate for rating purposes before ordering
examinations, which are often unnecessary.
In addition, VBA should accelerate the development of software that
seamlessly translates relevant information from VHA medical
examinations performed by treating physicians into appropriate DBQs for
VBA rating specialists. This free flow of electronic health data would
save veterans time and VBA resources by further eliminating unnecessary
VBA compensation exams.
Fourth, Congress and VBA should expand and create new authorities to
rapidly award partial or temporary benefits to disabled
veterans when the evidence of record clearly supports such
awards.
VBA currently has the authority under 38 CFR 4.28 to issue
prestabilization ratings for veterans who are discharged from active
duty due to severe injuries or illnesses that are not yet fully
stabilized or healed, and which cause significant limitations in their
ability to be employed. VBA also has rules to award intermediate rating
decisions with deferred issues as discussed in M21-1MR, Part II,
Subpart iv, Chapter 6, Section A. Intermediate rating decisions for
multi-issue claims can be made when the record contains sufficient
evidence to decide some of the claimed issues, including service
connection, even though remaining issues require further development,
and will be deferred. Although VBA has had these authorities for a
number of years, VBA rarely takes advantage of them to provide at least
partial or minimum benefits to veterans on an expedited basis. Concerns
about ``double work'' and performance standards that fail to properly
credit these two ratings actions have discouraged the widespread use of
these valuable rating authorities.
DAV believes that both prestabilization and intermediate ratings
should be encouraged and expanded to apply to additional circumstances.
Currently, prestabilization ratings can only be awarded at two rating
levels--50 percent and 100 percent--thereby limiting the number of
veterans who could benefit from this authority. DAV recommends that a
third level--30 percent--be added in order to rapidly award at least
some minimum level of benefits to veterans who need support in their
recoveries. The 30 percent rating would also open the door for veterans
to receive other important benefits, such as vocational rehabilitation,
more quickly to support their transition. In addition, we would
encourage Congress and VBA to expand the use of intermediate ratings by
creating a category of ``interim'' or ``temporary minimum'' ratings for
claims in which the evidence of record is already sufficient to support
at least a minimum service-connected disability rating. Similar to
intermediate ratings, these ``interim'' or ``temporary minimum''
ratings should not slow or impede the regular development and
processing of the rest of the claim. With the adoption of paperless e-
folders and smart processing, all of these temporary rating authorities
could be more easily accomplished without the risk of ``double work''
by VBA.
Although these temporary rating authorities would not directly
reduce VBA's workload or the backlog, providing a rapid award of at
least some benefits, based on the available records, to disabled
veterans would increase overall confidence in the claims process, and
likely help to reduce the number of appeals filed by claimants. Most
importantly, these changes would expedite much-needed assistance into
the hands of veterans and their families during difficult transitions
and recoveries.
Fifth, Congress should enact new legislation to provide a presumption
of service connection for tinnitus and hearing loss for
veterans who served in combat or whose military occupation
specialty (MOS) exposed them to high levels of noise.
During their military service, many veterans were exposed to
significant acoustic trauma from very high levels of noise caused by
heavy machinery, aircraft, explosive devices or numerous other causes.
As a result, many of them later in life develop hearing loss and
tinnitus, but often have a hard time proving it was due to their
service because of inadequate testing and record keeping while in
service. Tinnitus is the number one service-connected disability from
all periods of service, with more than 800,000 veterans receiving
disability compensation, and that number has steadily grown each year.
Over 700,000 veterans have been rated for hearing loss, making that the
second highest total for service-connected disabilities. By creating a
reasonable presumption, not only would thousands of veterans receive
compensation to which they are entitled, but VBA would be able to
redirect resources from unnecessary development of these claims to
address its other needs. Both the affected veterans and VBA would
benefit from this limited and reasonable presumption.
Sixth, Congress should enact legislation to create a new Veterans
Economic Opportunities Administration inside VA, which would be
comprised of the Vocational Rehabilitation and Employment
Service, Education Service, the Department of Labor's Veterans
Employment and Training Service, and other related offices and
functions, in order to allow greater focus by VBA on
successfully fixing the claims processing system.
DAV and our partners in the Independent Budget recommend the
creation of a new Veterans Economic Opportunities Administration (VEOA)
which would not only help to support veterans seeking new employment
and economic opportunities, but would also indirectly support VBA's
transformation efforts. By removing responsibility for managing both
the Vocational Rehabilitation and Employment (VR&E) and Education
Services, this change would allow VBA leadership to concentrate more
exclusively on claims processing reform. Given the dismal record of the
Department of Labor's Veterans Employment and Training Service (VETS)
over the past two decades, this reorganization would also allow greater
focus and synergy with VA on employment issues, a critical priority for
veterans, particularly younger veterans. Moving VETS to VA would also
help to protect funding for veterans employment programs since all VA
funding is currently exempt from sequestration cuts, while DOL programs
are not.
Mr. Chairman, that concludes my testimony and I would be happy to
answer any questions that you or other Committee members may have.
Chairman Sanders. Mr. Violante, thank you very much not
only for the work that the DAV does but for your excellent
testimony.
Every Member of this Committee and all of these service
organizations are deeply, deeply concerned about the backlog
and we want to move that process forward as rapidly as we can.
I think the testimony that we have heard today from General
Hickey and others is that, among other things, the VA is now
processing more claims than they ever have before. And, they
took a detour in appropriately dealing with the Agent Orange
issue.
Mr. Stichman, what I heard you say is, in fact, that the VA
did exactly the right thing in terms of responding to the
illnesses suffered by our soldiers who served in Vietnam, and
they did so in a prompt and accurate way.
Would you elaborate on that?
Mr. Stichman. Yes. Your statement is accurate. They re-
decided 150,000 past claims and 60,000 new claims in a speedy
way using good management techniques by giving the cases to a
group of adjudicators whose time was focused on that task alone
at the same time that the agency was dealing with the backlog.
Chairman Sanders. So, in the midst of a lot of criticism
being leveled at the VA, some of that being appropriate, on
this issue you think they actually did a pretty good job.
Mr. Stichman. Yes, and I know that because as class counsel
we are given copies of all the decisions the VA makes; and we
have been spending the last couple of years communicating with
the class members and we do find some mistakes. People make
mistakes on claims adjudications. That will always be true, but
the percentage of correct decisions is much higher than in
prior administrations in implementing the Nehmer consent
decree.
Chairman Sanders. Thank you very much, Mr. Stichman.
Mr. Violante, you have indicated in your view, DAV's view,
that the VA is, ``on the right path.'' I think we all
understand that the year 2013 in the 21st century there is no
choice but to go forward into a paperless system. The paper
system can no longer be used.
Talk a little bit about what you see them doing right and
then give me some suggestions, which you did make one. If you
were sitting up here, what would you do; is it the same
question asked General Hickey, what legislatively can we do to
improve the situation? And say a few words, if you might, on
this 60-day requirement, what some of your concerns might be
about that.
Mr. Violante. Thank you, Mr. Chairman. Let me say that I
have been in DC now for 30 years. I have been involved in
veterans issues for most of that time and I have never seen
such openness with the leadership at the VA central office.
They brought us in. They talked to us. They listen to us
when we talk. So, that is helping VBA go down the right path.
We believe that what they are doing with VBMS is the right
thing to do to get into a paperless situation.
I think what we must understand is this is not being done
in a vacuum. At the same time, they are processing over a
million claims annually which, in my mind, is something
phenomenal. I think their Quality Review Teams are what we have
asked for for a long time. It will help ensure that their
accuracy is improved.
Their training program is better now than it was years ago.
So, in those areas that is where we are seeing improvements.
Chairman Sanders. Let me just interrupt you, Mr. Violante.
My understanding is the DAV helps more veterans than perhaps
any other organization in the country move their claims
forward, is that correct?
Mr. Violante. That is correct.
Chairman Sanders. So, you have today and have had in the
past some experience in this whole process.
Mr. Violante. That is correct. Yes. We represent roughly
about 300,000 veterans, about a quarter of those veterans
filing claims.
With regard to the 60 days, we would not like to see that
shortened only because 50 percent of the veterans are
unrepresented. We certainly encourage veterans that we work
with or claimants that we work with, if there is no additional
evidence or they can get their evidence filed early, to do so.
So, we would not like to see changes there.
A couple of things legislatively we would like to see would
be with regard to the recommendations I made about requiring
the VA to consider credible, competent medical evidence that is
adequate for rating purposes.
Right now, we hear from the field, from our people, that in
some cases where the medical evidence is sufficient to be
rated, the fact that it comes in from a private physician
triggers an unnecessary examination.
I think also there should be more emphasis put on partial
claims. In other words, I walk in the door. VA looks at my
records. They see I was involved in an IED explosion. They see
I have a through-and-through wound from the shrapnel. I have
ringing in my ears. You know, those can be adjudicated quickly.
The other claims for PTSD, for Post Traumatic Brain Injury,
they can continue to develop those but I should walk out of
there with a check immediately because in the record is
evidence establishing, you know, those injuries.
So, we would like to see more done with regard to
intermediate or partial claims.
Chairman Sanders. OK. Thank you very much, Mr. Violante.
Thanks again for what the DAV does.
Mr. Thompson, you have a unique perspective on this issue,
given the fact that you were doing exactly what General Hickey
is doing today. We look at so many numbers to try to measure
the VA's progress. It is kind of difficult to deal with all
those numbers.
VA, Congress, and stakeholders examine mountains of data in
an attempt to gauge where progress is being made and which
efforts are producing results.
What measurements or data do you think are the most vital
for this Committee, VA leadership, and, most importantly,
veterans to use to measure VA's performance as well as the
success or failure of their transformation efforts?
Mr. Thompson. Mr. Chairman, I think the single most
important measure is the quality and accuracy of the decisions
made. You can do everything else but if you get that wrong it
is a major problem.
I would say the second issue has to do with both the cycle
times, or, the average days to complete as VA refers to it.
This is a measure that is looking at the past. And then, they
have the measurement of the age of cases in the inventory,
average days pending. That is a look at the future.
So, if those average days pending are in decline, as I
understand they are now, that is giving you some insight as to
where the workload is headed.
If I might take my hat off as a representative of the
National Academy and speak as a private citizen who has some
familiarity with this issue, I think that until transformation
is done, until they actually have these tools available to
them, this still will remain overwhelmingly a people process
inside regional offices.
It will require a large number of people handling the work,
and it is my belief that they need more people than they have
today. I believe they need thousands more employees considering
the volumes, not just pending claims but looking at how much
appeals work is sitting out there, and all of the things they
are trying to do simultaneously.
I commend them for what they are trying to do but that is
the heaviest lift I can imagine. In my personal perspective, I
think they need more people.
Chairman Sanders. I appreciate that thought. Would you want
to add any other advice in terms of what this Committee could
do legislatively based on your years of experience?
Mr. Thompson. Well, I have heard numerous discussions about
DOD and I would offer this: 15 years ago I sat with my
counterpart in DOD, the Under Secretary, when we thought we had
a deal about securing the transmission of records from them to
us. The fact that it is still an issue suggests to me that they
may not fully be on board. If I were to spend time in terms of
trying to craft legislation, I think I would look down that
road.
Chairman Sanders. Well, let me thank all of you for your
valuable and interesting testimony, and we look forward to
working with you in the future. Thanks again.
This hearing is now adjourned.
[Whereupon, at 12:21 p.m., the Committee was adjourned.]