The Battle to End the VA Backlog
The
United States has made a long-standing commitment to its veterans to
compensate them for injuries and illnesses sustained as a result of
their service. The US Department of Veterans Affairs (VA) administers
the veterans’ disability compensation program. Over the last decade, the
number of pending disability claims filed has increased, and the VA has
struggled to keep pace. This has resulted in a growing backlog of
claims pending over 125 days. In March 2013, the backlog reached over 600,000, with over 900,000 total claims pending in the system. The VA, led by Secretary Eric Shinseki, has implemented a number of initiatives focusing on automation, personnel, and processes to try and update this outdated, paper-based system and address this enormous backlog of claims. Between March and December 2013, the backlog decreased 36.5 percent, yet it still represents over 50 percent of the claims waiting to be processed at the VA.. While there has been some progress to decrease the backlog, there is nothing to support which of these initiatives are working and which are not, nor is there evidence of planning beyond FY 2015. The VA needs established mechanisms to measure the effectiveness of each of these initiatives to plan for continual improvements to the process. Overall it must create an infrastructure that allows the disability compensation system to project future needs and adapt to a growing population of new veterans and even more complex injuries. The backlog may end in FY 2015, but the disability compensation process will continue. If the VA does not learn from its mistakes, it is bound to repeat them.
This report intends to:
1. Define the VA disability compensation system and its backlog,
2. Consider the challenges to the VA disability compensation system,
3. Provide recommendations on how to move the system forward so that the VA not only ends the disability backlog, but sets up a long-term plan to ensure that it never returns.
IAVA recommends the following:
Collecting Evidence
► In lieu of a joint, integrated electronic health record, the DoD and VA must deliver on the long overdue initiative to develop an interoperable electronic health record to expedite record sharing.
► DoD must adhere to its timeline to develop and fully implement an automated system to transfer service treatment records.
► DoD must deliver on its promise to require a service health assessment for all separating service members.
► The VA should analyze and publish data demonstrating the response rate of other federal agencies when contacted to provide veterans’ records for the claims development process.
► Congress should consider legislation requiring federal agencies to provide a response to VA upon receipt of request for veterans’ records.
► Congress should consider legislation to amend US Code, Title 38 to align requests for federal records outside of the VA system with similar requests for private records.
► The VA needs to re-assess the protocols in place to provide customer service to veterans, including mechanisms for requesting, scheduling, and notifying veterans of compensation and pension exams.
► The VA must define metrics to measure the effectiveness of the programs to incentivize private providers to furnish medical records, the Acceptable Clinical Evidence initiative and Disability Benefit Questionnaires and develop and implement a plan for continual assessment and process improvements.
► The VA must analyze whether requirements that certain conditions are only assessed by VA clinicians are roadblocks to expediting the VA claims process and consider alternatives (such as a VA certification program for private providers outside of the VA) to train outside providers to provide these assessments.
Advancing Automation
► The VA must develop a plan to solicit continual feedback from users of their electronic systems, build improvements into the system and incorporate mechanisms by which it will determine future demands on the system and plan for system upgrades accordingly.
► The VA must improve customer service widgets in future upgrades of their electronic systems, including a live help application for the eBenefits portal.
► The VA must develop, track, and analyze metrics to determine the effectiveness of the segmented lanes initiative and continuously solicit process improvement recommendations from the users (the VA employees).
Improving Accuracy
► The VA should review and update as appropriate the VA Manual M21-4 Manpower Control and Utilization in Adjudication Divisions and VA Manual M20-2, Quality Control, to provide current guidelines to review and assess timelines, accuracy, workflow and productivity for VA disability claims adjudication.
► The VA must review and revise the current incentive program for VBA employees to integrate accuracy as a valued part of the disability claims process.
► The VA must define metrics to measure the effectiveness of the Challenge Training, Quality Review Teams and Segmented Lanes initiatives; develop and implement a plan for continual assessment and process improvements.
Enhancing Evaluation
► The VA must expand data access in regards to the effectiveness of all VA disability initiatives, including Challenge Training and the Systematic Technical Accuracy Review (STAR) program.
► The VA should conduct separate analyses of original and supplemental claims to determine the processing time, cause for delays in processing and needs to expedite each type of claim if the data show challenges to completing these claims differ.
Anticipating Need
► The VA, DoD, and Congress must continue to fund research, including passage of S. 1302, to better understand the health risks and long-term care needs for this newest generation of veterans.
► The VA must conduct an analysis of how previous generations’ demands on the VA system changed over time and use this information to inform how it prepares for the future.
► The VA must determine the geographic distribution of veterans and do a manpower analysis of VA staffing needs based on those distributions to ensure that both the Veterans' Benefits Administration and the Veterans' Health Administration are fully equipped to support veterans across the US.
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