Unclogging the Benefits System

The Veterans Benefits Administration (VBA) is up to its eyeballs in pending claims. Department of Veterans Affairs Secretary Eric K. Shinseki’s oft-repeated goal is to eliminate all claims pending more than 125 days and increase rating quality to 98 percent by 2015. Neither seems to be happening, and benefits for some of the nation’s most severely injured veterans have largely stagnated.

Sherman Gillums Jr., associate executive director of Veterans Benefits for Paralyzed Veterans of America, said what causes much of the VBA’s claims logjam is the large number of veterans attempting to navigate the claims process without service officers.

“If you have the right representation, like a Paralyzed Veterans’ service officer, and understand what you’re entitled to, you’ll get your benefits,” he said.

The Veterans Benefits Department, with 69 service offices nationwide, provides assistance to veterans and their families, ranging from bedside visits at VA medical centers to help ensure quality care to guidance in the VA claims process to legal representation for appealing denied claims. Over the past decade, Paralyzed Veterans has helped veterans identify benefits and complete and file claims resulting in nearly $1.5 billion in benefits.

Many states, counties and cities, as well as other veterans service organizations, also have veterans service officers. However, many aren’t aware of the host of options for assistance, or choose to go it alone. As a result, their claim forms frequently lack needed documentation, causing requests for additional information, unneeded denials, repeated filings and appeals.

As reported in The Independent Budget, “For a number of reasons, including the recent wars in Iraq and Afghanistan, the addition of new presumptive conditions for Vietnam and Gulf War veterans, and the economic recession, the number of new claims for disability compensation, including both first-time claims for benefits and claims for increases or additional benefits, has risen to more than 1 million per year.”

Worsening the matter, “In addition, both the average number of issues per claim and the complexity of claims have increased as complicated new medical conditions, such as traumatic brain injury, have become more prevalent.”

The Independent Budget is an annual report to Congress coauthored by AMVETS, Disabled American Veterans, the Veterans of Foreign Wars and Paralyzed Veterans.

In an effort to reduce waiting claims, the VBA has added employees, yet the number of pending claims continues growing. As of January 31, there were slightly more than 775,500 pending claims for disability compensation and pensions awaiting rating decisions. That was 289,000 more than the previous year.

An estimated 331,300 claims have been pending at the VBA longer than the target completion time of 125 days. That’s an increase of nearly 148,000, up more than 80 percent in the past year, meaning that more than half of all pending claims for compensation or pension are past the target time.

According to the VBA’s measurement, the accuracy of disability compensation rating decisions continues downward. Its quality assurance program reports only an 83 percent accuracy rate for the year ending on May 31, 2010. The VA Office of the Inspector General (OIG) found even more unreported errors and increased the error rate for the cases reviewed.

Much of the problem rests not just with unrepresented veterans trying to navigate the complicated VBA system, but with outdated, paper-centric processing. A 2009 OIG study found more than 300,000 claims had been misplaced—more than 140,000 were lost.

In recent testimony to Congress, Paralyzed Veterans’ President Bill Lawson explained that in the rush to resolve the claims backlog, the VA must be mindful that quantity must be sheathed in quality.

“Given the enormous pressure to reduce the backlog, we are concerned that there could be a bias toward process improvements that result in greater production over those that lead to greater quality and accuracy,” he told the Joint Committee on Veterans’ Affairs. “We urge the Committees to provide sufficient oversight of the VBA’s myriad ongoing pilots and initiatives to ensure that best practices are adopted and integrated into a cohesive new claims process and that each pilot or initiative is judged first and foremost on its ability to help VA get claims ‘done right the first time.’ ” 

Patrick McCallister is a reporter in Florida and frequent contributor to PN Magazine.

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