Running Head: VETERANS DISABILITY SYSTEM 1

The Veterans Disability System: How Do We Fix the Claims Backlog?
HCAD 660, 9041
Ceola Larry
March 29, 2015
Turnitin Score 2%

VETERANS DISABILTY SYSTEM 2
Abstract
The Department of Veterans Affairs (VA), once known as the Veterans Administration, was established in 1930. It is the second largest department of the federal government. Its main function is to provide benefits and support to veterans and their families. One of these benefits provided is disability compensation, which is administered by the Veterans Benefit Administration (VBA), one of three divisions of the VA. This compensations is given to U.S. military service members who are injured or develop illnesses while serving in the armed forces. Over the last 15 years or so, the disability claims, which allow these service members to receive compensation, have grown to such an amount, that the VA has fallen drastically behind in processing these claims. This has lead to an overwhelming issue, which has been labeled as the “claims backlog”. By the end of 2012, the claims backlog had reached over half a million claims. The VBA has implemented a Transformation Plan that hopes to solve this problem by the end of 2015. This report will discuss the veterans disability claims system and the role of human resources in the plan to eliminate the disability claims backlog.
Keywords: VA, veteran, disability compensation, claims, VBA

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The Veterans Disability System: How Do We Fix the Claims Backlog?
Knowledge
The VA is an organization that provides benefit programs for veterans, their families and their survivors. Disability benefits date back as far as the late 1700s, during the Revolutionary War; however, only about 27 percent of those soldiers received any type of compensation. Because of this, compensation for soldiers was eventually federally mandated. With this action, compensation would be more accessible to those who were eligible. By 1921, the Veterans Bureau was established; however, the majority of submitted disability claims were denied, due to the embezzlement of millions of dollars by the bureau’s director. By the time of the Great Depression, more than 45,000 veterans gathered in Washington, D.C. to demand they be given their disability compensation (Villarreal & Buckley, 2012). Since its creation in 1930, the VA has addressed the concerns and needs of millions of veterans by providing a number of benefits to help them transition back into civilian life; however, the number of claims have continued to grow. Despite the fact that the VA has a huge responsibility in providing these benefits to veterans, it has been somewhat of a difficult operation. For years, the VA has been criticized for not obtaining promised services to its veterans, and having inadequate facilities. By 1999, the VA Secretary, responded to all veterans and VBA dissatisfaction that the VA’s top priority would be to improve the timeliness of compensation and pension examinations (Weeks et al., 2003). By the turn of the 21st century, veterans continued to voice their dissatisfaction with the lengthy submission and the decision of the claim. In a 2007 testimony to the House Committee on Veterans Affairs, it was recognized that the Veterans Health Administration (VHA) faced
VETERANS DISABILITY SYSTEM 4 difficult challenges in delivering a wide range of services to highly diverse populations (Cox, 2011). By 2011, it was reported that 3.9 percent or approximately 870,000 veterans had disability claims pending (Villarreal & Buckley, 2012). Service members are eligible for disability compensation once they leave active-duty with a service-connected disability or health issues. In order to receive this compensation, they must go through a claims process. The process consists of eight steps; however, the steps may vary in regards to the complexity, amount of evidence to gather, and the type of claim that is submitted. Service members should submit as much evidence as possible with their claim to shorten the processing time. The first of the eight steps is when VA receives the veteran’s claim. The second step is when the claim is assigned to a representative, and is now under review for any other evidence. The third step, known as the gathering of evidence, is the representative requesting evidence from the veteran, medical professionals, government agencies, or any other authority. By the fourth step, which is the review of evidence, the representative has determined that all evidence has been received. If for any reason more evidence is needed at this time, the claim may possibly go back to the gathering of evidence step. The fifth step recommends a decision on the submitted claim, and prepares the documents detailing the decision. The decision is reviewed, and a final award approval is made with step six. Step seven allows the representative to prepare the claim decision packet to be mailed to the veteran, and the final step verifies that the VA has sent the decision packet to the veteran that includes details of the claim decision. The processing time of a submitted claim will depend on the type, complexity, number, and the availability of evidence needed. Step three is the most critical, and usually where a
VETERANS DISABILITY SYSTEM 5 bottleneck effect occurs in the processing of the veteran’s claims.
Comprehension
For many years, the VA has tackled the problem of fraud, waste, and mismanagement when dealing with the Veterans Disability Compensation Program (C&P). This program falls under the VBA. Until recently, signs of improvement had given little reassurance of the system getting better. That was because of the overwhelming number of veteran’s disability claims. The number and complexity of these claims has lead to the VA not being able to process them quickly enough, thus causing undue hardship on thousands of veterans. The Office of Human Resources and Administration (HR&A) sets the direction and articulates the vision of the VA by directing policy and operational functions within the VA programs (U.S. Department of Veterans Affairs, 2013). Part of its mission is to make sure veterans and their family members are taken care of. The C&P, over the years have become a big political issue (Luk, Shiner, Watts, Zubkoff, & Schlosser, 2010). This is because veterans have continually reported their dissatisfaction with the long processing times it takes to see what the decision is in reference to their submitted claims. By 2009, the average processing time on all rating and non- rating decisions were 120.9 days (Luk et al., 2010). Tremendous pressure was put on the C&P to shorten this time. Examination timeliness has been one of the biggest issues that have contributed to the backlog of veterans’ disability claims (Luk et al., 2010). In order to improve timeliness, national performance measures were used to identify high-performing Veterans Health Administration (VHA) facilities (Luk et al., 2010). These facilities were said to have excellent leadership support, a strong C&P leader, good relationship with their local VBA, and examiners who
VETERANS DISABILITY SYSTEM 6 understand how to conduct C&P examinations (Luk et al., 2010). It was noted that high-performing facilities kept frequent contact with their local VBA offices. By having this relationship, the local VBA’s could tailor their management of the C&P process to the specific needs of the veterans (Luk et al., 2010) which would allow for timely examinations. Since 2009, the VBA has recognized various issues contributing to the claims backlog. The first being the decision made by the VA’s Secretary to add three additional presumptive disabilities for those veterans exposed to the herbicide Agent Orange (U.S. Department of Veterans Affairs, 2013). Other issues include regulation changes for processing Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) claims, involvement with ten years of war, with high injury survival rates, growth in the average number of claims being filed by each veteran, and the success of extensive use of programs that encourage veterans to submit their claims (Villarreal & Buckley, 2012). In 2013, the General Accountability Office (GAO)) testified before Congress that there were internal and external issues that affected the disability claims causing the overwhelming backlog (National Council on Disability, 2013). Key internal issues were identified as lost or misplaced evidence, claims needing additional evidence, examinations requested by the VA, late transfer of information from Department of Defense (DOD) to VA, transfer of the claims file, and claims where no action was taken (National Council on Disability, 2013). Although these issues have compounded to the already overwhelming backlog, the VBA has put forth innovative ideas to assist in the improvement of their processes. Application For years, the VA has been plagued with the consistent growing of service-connected
VETERANS DISABILITY SYSTEM 7 disability claims. Although some improvements have been made over the years, veterans are still waiting much too long for a claim decision. In the last six years, however, it seems that the VA has made significant progress in decreasing the claims backlog. The creation of the Joint Virtual Lifetime Electronic Record (VLER) by the VA and DOD (U.S. Department of Veterans Affairs, 2013), has made it possible for health care to be shared by the VA and non-VA health care providers. Because veterans see both types of providers, the VLER makes it easier for providers to share certain parts of the veteran’s health record securely in real time. The electronic health record has greatly improved the overall quality of care for veterans. The VA has implemented a Transformation Plan that hopes to eliminate the claims backlog within 125 days and with a 98 percent accuracy rate by the end of 2015 (U.S. Department of
Veterans Affairs, 2013). This transformation comes at a time when all need to recognize that the backlog of disability compensation for veterans is unacceptable, and has been for over a decade. Equipped with initiatives that involve integrated people, process, and technology, the VBA is totally focused on giving veterans, family members, and survivors, benefits on time and first-rate service. It realizes that its employees are the key to its success and have come up with cross-functional teams to better service the claims’ process. In 2011, Challenge Training was instituted and Quality Review Teams (QRT) followed in 2012, in order to improve employer training and accuracy (U.S. Department of Veterans Affairs,
2013). Just as employees help to bring about the success in the process, process improvement is needed. The VBA has developed a “Design Team” whose job is to develop and test process
Changes. This action verifies that the changes to the process are effective and can be implemented nationwide.
VETERANS DISABILITY SYSTEM 8 Technology plays a critical part in reducing the claims backlog. The Veterans Management System (VBMS) was implemented in 2012, which is an electronic claims processing system (U.S. Department of Veterans Affairs, 2013). This change in technology hopes to significantly reduce, and altogether eliminate the existing claims backlog. The VBA hopes to have 75 percent of claims submitted in this format by 2015. Another vital part in the VBA’s technology transformation is the 2013 release of a new online application called eBenefits (U.S.Department of Veterans Affairs, 2013). This is a fully digital operating system that allows veterans to file their claims electronically, and have the access to upload digital images of their supporting documentation. This allows a Fully Developed Claim (FDC) to be filed by veterans that has all their service medical and personnel records, thus significantly reducing the wait time. FDC’s are probably the most critical in order for the VBA to achieve its goals.
Analysis
The VA has argued that the claims backlog is due to several factors; however, one of the most disturbing is employee training, in which the VA seems not to recognize. It was noted in a testimony presented before the House Committee in Oversight and Governmental Reform that department administrators lacks the knowledge on accurately describing, diagnosing, and documenting veterans’ disabilities (Villarreal & Buckley, 2012). Another big challenge that the VA has faced is claims that are being filed requesting veterans to receive post-traumatic stress disorder PTSD treatment. Administrators are having problems with correctly diagnosing and compensating veterans for PTSD and TBI. According to a report by the Office of the Inspector General (IG) (U.S. Department of Veterans Affairs, 2010), PTSD,
TBI, and a few other disability claims were consistently mismanaged (Villarreal & Buckley,
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2012). The IG found that evaluators do not understand the medical examination reports, thus not being able to make accurate determinations (Villarreal & Buckley, 2012). It was noted that the previous wars’ veterans claimed between two and four injuries, while the Global War on Terror (GWOT) veterans claim between nine and ten injuries. The GWOT claims brought about much more complex disability claims. These claims have been held up due to the VA not adding PTSD care to its budget. The VA has now begun to fund more programs in order to treat PTSD; however, this action has taken place only because of the pressure from the public and many other advocacy groups (Cox, 2011). Once paperwork is submitted to file a disability claim, many veterans have experienced difficulty in presenting additional documents needed in order to continue processing their claim.
In regards to their personnel or medical records, many don’t know how to get the necessary documents they need, thus causing longer wait times for claim decisions. After submitting their claims, some veterans feel that those working in VA are not friendly and can’t relate to their issues because they are not veterans themselves (Veterans Today, 2009). Veterans feel as if more emphasis is place on rules, regulations, and the paperwork involved, than actually caring about the veteran and trying to do whatever necessary to speed up the claims process (Veterans Today, 2009). Synthesis The veterans’ disability claims system has always had serious delays in processing claims in a timely manner. It has been noted that these delays have a critical impact on the lives of service members as they transition to their civilian lives. The VBA has and continues to implement processes to help in this claims issue.
VETERANS DISABILITY SYSTEM 10 The National Council on Disability (NCD), has added their voice to help advocate in getting long-term solutions to end the claims backlog. It says public policy changes are needed and contributions from stakeholders are critical to aid in this process. Some of the policy options that have been suggested in order to decrease the claims backlog are improving the process once the service member goes from active duty status to becoming a veteran. All service members must complete a physical examination once they are discharged from military service; however, there is a pre-separation examination that is voluntary, but not mandatory. Having mandatory pre-separation physical and mental examinations would equip the service member, his or her unit, and the national Personnel Records Centers (NPRC) with digital and paper copies of examinations, which would help speed up the claims process. Veterans should be able to purchase their own health care policy and also have a Health Savings Account (HSA). Although the VA system strongly encourages veterans to receive their care there, veterans should be afforded the opportunity to have more flexibility in the VA health care system. This is because the VA has been known for its poor quality and inefficiencies (Villarreal & Buckley, 2012). A GI Health Care Bill could help provide this, just as veterans have an Education Bill that allows veterans to get an education. Transferring administrative services from federal to state level may prove to benefit the states, allowing them to hire qualified personnel to help in the claims process. The NCD encourages coordination and collaboration among the legislative and executive branch to assist with the claims issue. The ultimate goal is have a streamlined and accessible electronic claims application and health records system.

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Evaluation
It has been reported that in the year 2010, 2011, 2012, the VBA completed one million claims (U.S. Department of Veterans Affairs, 2013); however, many more claims are still pending and exceed the number processed. For FY 2012, there was a reported increase in the accuracy standards since the implementation of Challenge Training and QRT’s from 83 percent to 86 percent under the VBA’s Transformation Plan (U.S. Department of Veterans Affairs, 2013). The goal is to reach 98 percent by the end of 2015. The Senate Committee on Veterans’ Affairs in June 2013, reported that two-thirds of 851,000 claims were still waiting on a decision (National Council on Disability, 2013). There is serious concern whether or not the VA can meet its 2015 goal of eliminating the backlog of claims and getting a decision on disability ratings within 125 days. President Obama re-affirmed the disability claims backlog as a national priority in his State of the Union address by stating, “we’re slashing the backlog that had too many veterans waiting years to get the benefits they need”(Washington Post, 2015). The VBA’s Transformation Plan is currently the best plan that the VA has implemented aggressively attacking the claims backlog. This plan is efficient and has implemented systems that are continually working on improving digital health and evidence files, and appellate procedures. These systems can help empower veterans and service members to take control of their own claims, which can allow them to get faster decisions, and at the same time, personal dignity, and quality of life (National Council of Disability, 2013). A tremendous amount of retraining, reorganizing, streamlining, building and implementing technology have been put into the plan in hopes of eliminating the backlog by the end of 2015.
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References
Cox, C. (2011). The troubled history (and future) of veterans’s benefits. Harvard Political Review. Retrived from http://harvardpolitics.com/arusa/the-troubled-history-and-future-of-veterans-benefits/
Luk, B., Shiner, B., Watts, B., Zubkoff, L., & Schlosser, J. (2010). Strategies to improve compensation and pension timeliness: Lessons learned from high-performing facilities. Military Medicine, 175(12), 978-982.
National Council on Disability. (2013). Clearing the backlog and facilitating benefits for veterans with disabilities. Retrieved from http://www.ncd.gov/publications/2013/11122013/
U.S. Department of Veterans Affairs. (2010). VBA audit of national call centers. Office of Inspector General. Retrieved from http://www.va.gov/oig/52/reports/2010/VAOIG-09-01968-150.pdf.
U.S. Department of Veterans Affairs. (2013). About HR&A. Office of Human Resources and Administration. Retrieved from http://www.va.gov/employee/
U.S. Department of Veterans Affairs. (2013). Capability marks major milestones in VA transformation to digital claims process. Office of Public Affairs. Retrieved from http://www.va.gov/poa/pressrel/pressrelease.cfm?id=2453
U.S. Department of Vetrans Affairs. (2013). Department of veterans affairs (VA) strategic plan to eliminate the compensation claims backlog. Veterans Benefits Administration. Retrieved from http://www.benefits.va.gov.transformation/about_transformation.asp
Veterans Today. (2009). House subcommittee reviews claims process for veterans. Retrieved

VETERANS DISABILITY SYSTEM 13 from http://www.veteranstoday.com/2009/06/23/house-subcommittee-reviews-claims-process-for-veterans/
Villarreal, P. & Buckley, K. (2012). The veterans disability system: Problems and solutions. National Center for Policy Analysis. Retrieved from http://www.ncpa.org/pdfs/bg166.pdf.
Washington Post. (2015). Transcript: Obama’s state of the union address. Washington Post Politics. Retrieved from http://wp.com/politics/transcript-state-of-the-union-address-2015.html
Weeks, W.B., Mills, P.D., Waldron, J., Brown, S.H., Speroff, T., & Coulson, L.R. (2003). A model for improving the quality and timeliness of compensation and pension examinations in VA facilities. Journal of Healthcare Management. 48(4), 252-261.