Claims today are more complex, involving nine to 11 medical issues each, on average, versus an average of two raised by claimants after World War II. With claims increasingly complex, with more conditions eligible for payment and with the VA still operating an archaic paper-driven process, 65 percent of pending claims remain in “backlog” status.
That means they’ve been on file more than 125 days without a decision.
The size of the current backlog is 558,000 claims out of an inventory of pending cases just below 900,000. VA Secretary Eric Shinseki promised two years ago to eliminate the backlog by 2015, and to raise the accuracy rate of claim decisions to 98 percent, up from 84 percent.
A plan to get there is being executed, said the VA’s under secretary for benefits, retired Air Force Brig. Gen. Allison Hickey. She and other senior officials explained key elements of it to reporters Wednesday.
They include adopting a new electronic claims processing system VA-wide, which still sounds like a Herculean task. But the effort also involves better training for claims handlers and a new operating model for how claims are categorized to move faster through the system on one of three tracks.
There will be an “express” lane for uncomplicated claims of one or two health conditions, and also for “fully developed” claims that include all the evidence and supporting documents needed to process, typically compiled for vets with help from service officers of major veteran organizations.
Another “special operations” lane will handle claims requiring extra attention because wounds or illnesses are particularly serious, or the veteran is homeless or suffering a financial hardship.
Finally a “core” lane will handle the roughly 60 percent of claims, those seeking compensation for more than two medical conditions and clearly needing more evidence-gathering to process.
Claims will be routed into one of these three segmented lanes through a new intake processing center, Hickey explained.
She estimated that 20 percent of claims could be resolved using the express lane, with the other 20 percent triaged into the special operations lane where claim reviewers and raters with greater skills and experience will work on them as teams.
The new operating model will be in 16 VA regional offices by Sept. 30 this year and in all remaining regions by December 2013, Hickey said.
Having served in her post 13 months, Hickey knows how frustrated members of Congress are with promises over many years that the claims backlog was being addressed. But no VA official called to testify in recent memory has been so verbally abused as Hickey was last month by Rep. Bob Filner of California, ranking Democrat on the Veterans Affairs Committee.
Filner, who is running for mayor of San Diego, said the VA should address its backlog by starting disability pay as soon as claims are filed on the assumption most veterans are honest and most claims properly documented, just as the IRS does for tax filers. Only on discovering otherwise would payments stop and the VA presumably be tasked to seek restitution.
At the June 19 hearing, Filner also berated representatives of major veterans organization for not being willing to “blow up” the current claim process despite how slow and inaccurate it is.
Hickey didn’t mention Filner’s harangue on Wednesday but began her press call by noting that 61 percent of current claims are from veterans who have filed previous claims.
“They have a new (medical) issue or the issue they have is aggravated,” Hickey said. “They have new medical evidence that says it’s gotten worse. They come back to us to have us re-rate that (condition) for a higher percentage level.” Of veterans filing these supplemental claims, she added, 77 percent already are receiving some VA disability compensation.
But the VA, she said, is taking every step possible to transform its claim processes and to retrain and reorganize staff to address the backlog. She projects that backlog will fall to 60 percent of pending claims by the end of September and to 40 percent by Sept. 30, 2013.
For the past two years, the VA had 2,300 of its most experienced claims processors – 37 percent of its entire claims staff – handling retroactive review of 260,000 Agent Orange cases affected by the 1985 Nehmer court ruling. That review is now complete, with 131,000 Vietnam veterans or survivors having received $3.65 billion in retroactive payments.
Starting this month, those 2,300 processors are back to handling current claims.
“I didn’t get additional resources to do” Nehmer cases, Hickey said.
Vietnam veterans will continue to file new claims as they are diagnosed with one or more conditions from a list of illnesses, including heart disease and Type II diabetes, that are presumed to be linked to Agent Orange exposure, no matter how brief the stay in Vietnam during the war.
Other key tools that Hickey named for addressing the backlog remain pilot programs, but all are on schedule to be fielded soon departmentwide.
The paperless claim processing technology, called the Veterans Benefits Management System, involves scanning claim files into digital format, which then can be searched easily by reviewers and raters to speed their decisions. The results of operating the system at four pilot locations show electronic claims being decided, on average, in 119 days versus an average of 250 days to reach a paper claim decision, Hickey said.
By Tom Philpott
Tacoma News Tribune
July 14, 2012
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