In setting an ambitious goal three years ago to end the Department of Veterans Affairs' disability claims backlog in 2015, VA Secretary Eric Shinseki exposed himself to criticism, including calls to resign as the backlog rose.
But that bold goal, Shinseki said, also helped VA get the funding it needed to modernize operations, including to phase out an inefficient, paper-driven claim processing system.
"If I had written a plan that said we're going to end the backlog in 2025, I wouldn't have gotten any resources," Shinseki said in an interview while he visited the VA regional claims processing office in Newark, N.J.
With extra billions of dollars appropriated for claims processing and other "transformative" initiatives, VA's backlog finally is falling. It stood last week at 536,400, down from 608,000 in March. Shinseki said he remains confident it will be gone in 2015. He sounds a little less confident of ending homelessness among veterans by that year, another determined goal.
Regardless, the retired four-star general and former Army chief of staff doesn't regret setting bold objectives.
"I've been writing plans all my life. I never wrote a tentative plan. That's not what you expect from a guy you want to solve a problem."
A VA claim is in "backlog" if not decided within 125 days. When Shinseki became secretary, early in 2009, VA tracked claim performance with a different yardstick: average time to decision. The average then was 191 days, Shinseki said. The average sought was 125 days.
"So if I completed a claim in one day, and another claim in 249 days, that's a 125-day average, and that would have ended the backlog," Shinseki said. "It just seemed to me a bad way to define the problem or try to solve it. So we said: No claims over 125 days."
As newly defined, the backlog was 180,000 by September 2009. Over the next three years it more than tripled, passing 600,000, even as VA hired thousands more claim processors. VA was deciding a million claims a year, yet the backlog grew with as many as 1.3 million claims pouring in.
Only part of the flood of claims is from veterans who fought in Iraq and Afghanistan. As Shinseki explains to Congress and to his own claims staff, it was his decisions to aid more veterans, including from the generation he went to war with in Vietnam, that helped to create the backlog.
Under Shinseki, VA simplified the process for filing post-traumatic stress disorder claims from veterans of all wars. He made compensable more illnesses for 1990-91 Gulf War veterans exposed to toxins and other health threats in that campaign. He also added ischemic heart disease, Parkinson's disease and B-cell leukemia to the list of ailments for which Vietnam veterans can receive disability compensation, on presumption wartime exposure to the defoliant Agent Orange caused these conditions.
This last decision alone resulted in 280,000 retroactive claims. As of last month, 166,000 veterans with at least one of these illnesses, or surviving spouses, received more than $4.5 billion in VA pay. Thousands of additional Agent Orange claims are being filed monthly.
Shinseki stands by his Agent Orange decisions, citing scientific studies. But for two years, VA had to reassign 2300 of its most experienced claim processors – a third of the staff – to review old claims that qualified for special handling under a 1985 Nehmer court ruling. Shinseki said he could be faulted for not better understanding requirements that Nehmer imposed so VA was better prepared for the extra workload.
"They had to go through every page of every claim. It wasn't enough to say, 'Vietnam, exposure to Agent Orange and therefore Parkinson's disease [so] grant service connection.' The Nehmerdecision required them to see if there was anything else in the file…page by page by page. And, by the way, Nehmer goes to the head of the line. Everything else waits…I should have asked more questions."
Shinseki promised in 2010 not only to end the backlog in 2015 but also to raise the decision accuracy rate to 98 percent, up from the low 80s. These goals, Shinseki guessed while visiting the claims staff in Newark last month, must have made a few of them "suck wind through your teeth."
That was also the reaction by some at headquarters, he told me.
"Somebody said, 'Is he crazy?' 'No, no, no,' I said. 'I'm just asking: Is this a good goal? If it is, then we will go figure out how to get there.' "
First priority was to begin to replace paper claims with electronic ones. Last month, six months early, VA completed rollout of an electronic claims processing program, the Veterans Benefits Management System. VBMS allows the 56 VA regions to accept new claims electronically. It also allows VA to accelerate a massive process of scanning existing paper claims into computers to be processed and decided faster and more accurately.
Earlier this year, as criticism of the rising backlog intensified, Shinseki set a two-month deadline to identify and complete 66,000 claims more than two years old. VA expedited the process for claims at least a year old using new provisional approval authority to start benefits based on evidence submitted to date. He ordered mandatory overtime of 20 hours a month for all claims processers. And VA established a partnership with the American Legion and Disabled American Veterans to have their claim experts certify claim packets they worked as "fully developed" and ready for decision.
To meet the 98 percent accuracy goal, Shinseki hopes for support from Congress and vet groups to redefine a term. VA now counts a completed claim as "accurate" if every medical condition identified is rated correctly. So if an individual claims 12 conditions, and one is rated wrong, the claim doesn't qualify as accurate in tracking VA performance.
The all-or-nothing approach ignores a lot of good staff work, Shinseki said. It would be more appropriate, he suggested, to base performance on percentage of conditions rated correctly, not claims flawlessly decided.
Under such a change, VA would have an accuracy rate today of 95 percent, just shy of the 98 percent mark promised by 2015, officials said.
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