Law to protect vets slows claims process

Law to protect vets slows claims process

By Tom Philpott, Special to Stars and Stripes
Pacific edition, Saturday, July 12, 2008



In the last decade, the Department of Veterans Affairs has doubled the number of disability claim processors on staff, and yet the average time to process a claim has climbed during that period from four months to six.

From January 2007 through June 2008, as VA added 2,700 claim processors to its inventory of 8,000, the average time to process a claim still fell unimpressively, from 183 days to 181.

"Something’s going on here that isn’t right, that needs to be fixed. I don’t know what the hell it is," said a frustrated Sen. Jon Tester, D-Mont., during a hearing Wednesday of the Senate Veterans Affairs Committee.

"In the 1990s you were at 120 days" to process a claim. "Was there something in the process that changed," Tester asked Michael Walcoff, deputy undersecretary for benefits for the Veterans’ Benefits Administration.

Yes, Walcoff said. Congress in 2000 passed the Veterans Claims Assistance Act. Since then, two-thirds of the time required to process a claim is committed to blocks of time set up to develop evidence to support the claim. A recent study of VA claims processing, conducted by IBM, confirmed that compliance with the VCAA has created bottlenecks for processors.

"It’s good law … set up to guarantee that veterans have certain rights and they are protected. It’s something we all agree with," Walcoff said. But courts have interpreted that law "in various ways that have made it very difficult to administer and have added time to the process."

Passage of the VCAA, in effect, overturned a 1999 decision by the Court of Appeals for Veterans Claims that veterans had to submit a "well grounded" claim for VA officials to be required to help them obtain further evidence — such as doctor files or witness statements — to prove their claim.

While the VCAA lowered evidentiary standards for veterans, it also spelled out in great detail what actions VA had to take, and what deadlines it had to set, to help veterans develop evidence to support claims.

When a claim is filed, the VCAA mandates that claim processors carefully analyze it and send a letter to the veteran explaining evidence on file and evidence still needed. The letter also must explain that VA will help obtain evidence if names and addresses of doctors or witnesses are provided and that VA will obtain government records pertinent to the claim.

But the VCAA letter also tells a veteran that he or she has 60 days to submit the required evidence. And if the claim is to be based on the medical findings of a private physician, the doctor too is given a 60-day deadline to submit medical records.

The process can be delayed further if their original claim fails to include a signed privacy form required for VA to request medical records from private physicians. "We then have to go back to the veteran to get the privacy form," Walcoff said. All of this, he said, is required by VCAA.

Some veterans’ service organizations and lawmakers have criticized VA for implementing the VCAA, and follow on court rulings, like a lumbering bureaucracy rather than like a dynamic agency bent on speeding up the claims process. VA officials told senators they soon will implement some of the IBM report recommendations to speed the claims process.

The study said, for instance, that the VA should reduce the 60-day period given veterans to provide evidence supporting their claim.

"We are shortening that to 30 days so we can act faster," said retired Navy Rear Adm. Patrick W. Dunne, acting undersecretary for benefits for the Veterans Benefits Administration. VA also will make the VCAA letter more understandable for veterans and make it available electronically in November after a software update.

VA disability claims have climbed by 5 percent from last year, to 883,000, the result of Iraq, Afghanistan and an aging veteran population. The claims backlog is still a hefty 390,000. Though decision timeliness remains a concern, said Sen. Daniel Akaka, D-Hawaii, committee chairman, decision finally are being handed down faster than claims are being filed.

But North Carolina Sen. Richard Burr, ranking Republican on the committee, said claim timeliness remains very frustrating for veterans and their families.

"Simply drawing more money and more personnel to the problem clearly — clearly — has not been the solution," Burr said. It’s time "to seriously explore other options" including conversion to paperless claims and overhauling VA’s overly complex disability rating system.

Howard Pierce, chief executive officer of PKC Corp., testified that his company in 2001 was tasked to set up a computerized decision model that could be used by VA disability raters and claim adjudicators. PKC analysts were stunned by the complexity of the decisions.

"What a rater is asked to do on a day-to-day basis is extraordinarily complicated. We live in a world of complexity in my company. We work with very challenging science. We have never seen anything more complex" than the VA claims system, Pierce said.

But Kerry Baker, with Disabled American Veterans, suggested other ways for VA to speed claim decisions and be fairer too. He said most claims still hinge on medical opinions, and VA should be more willing, as is the Social Security system, to accept well documented private medical opinions.

VA also should be required, "as a matter of fairness," to inform claimants on basic elements that render a private medical opinion adequate for rating disabilities. "VA relays this exact information to its own doctors when it seeks medical opinion," Baker said.

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The VA uses IMO's that we veterans obtain from private doctors at our personal expense that ranges from hundreds of dollars to thousands of dollars to have their doctors at the C&P exams specifically knock down the IMO's line by line, by whatever excuse they can come up with. Many IMO's that veterans obtain are a waste of money at the local VARO level but will allow the veteran to win upon appeal to the Board of veteran Appeals a process that takes 3-7 years. Hopefully the veteran will live long enough for the claim to be fairly adjudicated.

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