[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
FOCUSING ON PEOPLE: A REVIEW OF VA'S PLANS
FOR EMPLOYEE TRAINING, ACCOUNTABILITY,
AND WORKLOAD MANAGEMENT TO IMPROVE
DISABILITY CLAIMS PROCESSING
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, MARCH 20, 2013
__________
Serial No. 113-12
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado MICHAEL H. MICHAUD, Maine, Ranking
GUS M. BILIRAKIS, Florida CORRINE BROWN, Florida
DAVID P. ROE, Tennessee MARK TAKANO, California
BILL FLORES, Texas JULIA BROWNLEY, California
JEFF DENHAM, California DINA TITUS, Nevada
JON RUNYAN, New Jersey ANN KIRKPATRICK, Arizona
DAN BENISHEK, Michigan RAUL RUIZ, California
TIM HUELSKAMP, Kansas GLORIA NEGRETE MCLEOD, California
MARK E. AMODEI, Nevada ANN M. KUSTER, New Hampshire
MIKE COFFMAN, Colorado BETO O'ROURKE, Texas
BRAD R. WENSTRUP, Ohio TIMOTHY J. WALZ, Minnesota
PAUL COOK, California
JACKIE WALORSKI, Indiana
Helen W. Tolar, Staff Director and Chief Counsel
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
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C O N T E N T S
__________
March 20, 2013
Page
Focusing On People: A Review Of VA's Plans For Employee Training,
Accountability, And Workload Management To Improve Disability
Claims Processing.............................................. 1
OPENING STATEMENTS
Hon. Jeff Miller, Chairman, Full Committee....................... 1
Prepared Statement of Chairman Miller........................ 41
Hon. Michael Michaud, Ranking Minority Member, Full Committee.... 3
Prepared Statement of Hon. Michaud........................... 42
Hon. Tim Walz, Prepared Statement only........................... 43
Hon. Jackie Walorski, Prepared Statement only.................... 44
WITNESSES
Hon. Allison Hickey, Under Secretary for Benefits, Veterans
Benefits Administration, U.S. Department of Veterans Affairs... 5
Prepared Statement of Hon. Hickey............................ 44
Accompanied by:
Ms. Diana Rubens, Under Secretary for Field Operations,
Veterans Benefits Administration, U.S. Department of
Veterans Affairs
STATEMENT FOR THE RECORD
The American Federation of Government Employees.................. 56
The American Legion.............................................. 60
Iraq and Afghanistan Veterans of America......................... 61
National Organization of Veterans Advocates...................... 63
Paralyzed Veterans of America.................................... 65
QUESTIONS FOR THE RECORD
Questions From: HVAC Majority Members, To: VBA................... 67
Responses From: VBA to HVAC Majority Members..................... 68
Letter and Questions From: HVAC Minority Members, To: VBA........ 70
Responses From: VBA to HVAC Minority Members..................... 73
FOCUSING ON PEOPLE: A REVIEW OF VA'S PLANS FOR EMPLOYEE TRAINING,
ACCOUNTABILITY, AND WORKLOAD MANAGEMENT TO IMPROVE DISABILITY CLAIMS
PROCESSING
Wednesday, March 20, 2013
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, D.C.
The Committee met, pursuant to notice, at 10:00 a.m., in
Room 334, Cannon House Office Building, Hon. Jeff Miller
[Chairman of the Committee] presiding.
Present: Representatives Miller, Bilirakis, Runyan,
Huelskamp, Coffman, Cook, Walorski, Michaud, Takano, Brownley,
Titus, Kirkpatrick, Negrete McLeod, O'Rourke, Walz.
Also Present: Representative McCarthy.
OPENING STATEMENT OF CHAIRMAN MILLER
The Chairman. The Committee will come to order.
Good morning, everybody. Thank you for being here this
morning to talk about a topic that is not new to this
Committee, namely needed improvements to the disability claims
processing system.
As of this week, VA had nearly 900,000 pending claims, with
over 70 percent of those claims pending for longer than VA's
targeted processing time of 125 days.
Recently, VA has rolled out its transformation plan as a
means of addressing this growing backlog of claims. Pursuant to
a quick search of Merriam Webster's Dictionary,
``transformation'' means the act of changing in composition or
structure. Similarly, ``plan'' is defined as a detailed
formulation of a program or action.
What we have seen from VA so far does not amount to a
significant change in the culture of the organization, nor has
VA provided a very detailed formulation of the plans that they
have for moving forward, although it is my hope that VA is
truly committed to changing the culture of the department.
Most of what we have seen so far consists of repackaging
old initiatives with new PowerPoint presentations and
impressive buzz words. Speaking of buzz words, VA has
repeatedly stated that it plans on accomplishing its
transformation plan by focusing on people, process, and
technology.
Our purpose this morning is to focus on the first of these
three elements, which may be the most important element, and
that is people. Although much emphasis is placed on the process
and technology, I do believe that we should focus more on the
people that are doing the work.
There are thousands of men and women who, on a daily basis,
work throughout the Department of Veterans Affairs doing a
great job and those jobs should not go unacknowledged.
Nonetheless, the more people VA hires to process claims, it
appears the worse the department's productivity is.
[Chart]
The Chairman. Indeed, as the first chart that we will put
on the screen this morning shows, in 1997, the average VA field
employee processed 135 claims per year whereas in 2011, that
number had dropped to 73 claims per year.
[Chart]
The Chairman. Further, as the second chart shows, VA has
nearly three times as many field employees to do the work now
than it did 15 years ago.
Now, one would think that working fewer cases per employee
would result in higher accuracy rates, but accuracy is
stagnant, and as the budget has grown exponentially,
unfortunately, so, too, have the processing delays.
As I have stated many times before, there are many people
including myself who are losing patience as we continue to hear
the same excuses from VA about increased workload and increased
complexity of claims.
Let me just give you one example from VA's own budget
books, and I quote, ``The effect of the military draw-down on
VA's claims process is marked not only by a large volume of
claims being received, but also by increasing complexity of
those claims.''
``As a result of the pre-discharge counseling being given
to service personnel, veterans have been claiming more
conditions on their initial applications. Instead of the
traditional two to three disabilities per claim, regional
offices are dealing with 10 to 15 issues per claim.''
I could go on, but I just ask, does this sound familiar? It
should because what I just read to you came out of VA's
February 1994 budget submission.
Now, VA has and will encounter complications along the way.
However, VA's demonstrated history shows its inability, or
refusal, to forecast problems and anticipate its needs. And the
only people paying a price for this failure of VA are the
veterans. The time for excuses is over.
So, Under Secretary Hickey, we are here today to have an
honest discussion about the people who make up VBA, from file
clerks to RO directors to VA central office managers, and on
how you intend to transform this workforce through better
accountability and workload management practices.
I recently had the opportunity to travel to the Baltimore
Regional Office. I was able to observe new employees' challenge
training. I also learned more about the Station Enhancement
Training that the Baltimore RO will soon undergo.
Although proper training is important, I would like to
reiterate that that is not enough. VA also needs to remain
focused on accountability and better workload management
practices.
For example, one of the words we hear most when VA is
called before us is ``Nehmer.'' Nehmer, a class action lawsuit
that requires VA to prioritize certain Agent Orange
presumptions, did add significantly to VA's workload.
However, during the 111th Congress, Secretary Shinseki
testified before this Committee that VA would easily be able to
fast-track those claims. I quote, ``By 2013, we will be back to
where we are today at about 161 days to process a claim.''
Under Secretary Hickey, as you know, we are not there
today. On the contrary, we are at 280 days for an initial
rating decision.
Without better workload or surge capacity planning, I am
fear that VA is simply one national mission away from complete
collapse and utter failure. This is simply unacceptable.
So, again, we are here today to explore how the people who
make up VA can prevent this scenario from happening.
I want to thank Under Secretary Hickey for being here
today, as well as those who submitted statements for the
record.
I now yield to our Ranking Member, Mr. Michaud, for his
opening statement.
[The prepared statement of Chairman Miller appears in the
Appendix]
OPENING STATEMENT OF HON. MICHAEL MICHAUD
Mr. Michaud. Thank you very much, Mr. Chairman, for holding
this hearing today.
And I would like to take a brief moment to recognize that
it has been a decade since we started Operation Iraqi Freedom.
The wars in Iraq and Afghanistan have claimed 6,669 American
lives with over 50,000 wounded in action and countless others
suffering mental injuries as a result.
I want to thank all the veterans' advocates on this
Committee and in the audience who have worked hard to assist
these fine men and women who served our great Nation.
Since March of 2003, there has been much that we should be
proud of: the Post-9/11 GI Bill that ensured that these
veterans have the opportunity of an excellent college
education, record increase in budgets for the VA programs, and
services that have led to better care and access for our
Nation's veterans in rural areas.
But there is still much more to be done. Despite the
positive outcomes, we have a lot of challenges facing our
veterans and their families.
While the VA continues to process more claims than at any
other time in its history, demand continues to outpace
production. Today, as you heard, VA's total inventory is
approaching 900,000 claims with more than two-thirds of the
claims considered to be part of the backlog.
However, despite the growing backlog, I am encouraged by
some of the recent developments and by the shift in attitude of
some of VA's efforts to solve the backlog problem.
Nonetheless, while I appreciate the Secretary's goal of
having no veteran wait for longer than 125 days with an
accuracy rate of 98 percent by 2015, I question whether this
very, very aggressive, ambitious goal is achievable.
It would require the VA to complete approximately 3.4
million claims in two and a half years. To accomplish this
goal, the VA must start averaging the completion of
approximately 1.36 million claims a year. That is a 33 percent
increase in productivity.
These are loose numbers and I hope the VA does have better
ones. But in my mind, the math does not add up and I am not
sure how we are going to get there by 2015.
I also question whether the VA is being up front with
Congress about its challenges. In particular, does VBA have
enough employees to get the job done? I am not convinced that
it does. And is VBA getting all of the information that you
need from the Department of Defense in a timely fashion? I do
not believe that is the case either.
VA's ability to process claims in a paperless electronic
environment can only be as good as the information that goes
into the system. If you do not have the resources required and
you are not receiving information from DoD or other agencies,
we need to know about that.
Further, I am concerned that VBA is simply trying to
automate a claims process that at the end of the day does not
work. I hope to hear from you--ideas as to how the workload
management will change in the electronic setting.
Can VA visualize an electronic system in which veterans'
claims come not in as claims but is broken down in various
medical conditions?
You know, for the purpose of discussion, let's suppose that
13 medical conditions is in a claim. These 13 medical
conditions are not sent through the segmented lanes of
veterans' local regional office. They are sent to 13 regional
offices throughout the country electronically simultaneously
being adjudicated at the same time.
As you know, different ROs specialize in different medical
conditions. And when you look at the different codes out there,
the numerous amount of codes out there, it is very hard, for an
employee to know how to move those claims forward rapidly.
I think challenged ROs should get the easy medical
conditions while the ROs that do a great job might want to
handle the more complex conditions. And, more importantly,
veterans get paid as each medical condition is completed.
I challenge the VA to think outside the box. It is an old
adage that a benefit delayed is a benefit denied. Far too many
veterans are waiting far too many days to receive the benefits
that they have earned.
We are all working towards the same end goal, timeliness,
accuracy of disposing of these claims. If we are here to be
successful, we must work together to achieve a claims system
that lives up to the service and the sacrifices of our veterans
and soldiers as they defended this great Nation of ours.
So I would encourage you, Madam Under Secretary, as we move
forward with the VBMS system to think outside the box. It does
not necessarily have to be the way it has always been in the
past to approve these particular claims.
With that, Mr. Chairman, I yield back.
[The prepared statement of Hon. Michaud appears in the
Appendix]
The Chairman. Thank you very much, Mr. Michaud.
I want to welcome the panel that is with us this morning.
It is the only panel at the witness table this morning, General
Allison Hickey, the Under Secretary for Benefits with the U.S.
Department of Veterans Affairs.
We certainly appreciate your service. Thank you for being
here this morning. You are now recognized for five minutes.
Please proceed.
STATEMENT OF ALLISON HICKEY, UNDER SECRETARY FOR BENEFITS,
VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS, ACCOMPANIED BY DIANA RUBENS, DEPUTY UNDER SECRETARY
FOR FIELD OPERATIONS, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS
General Hickey. Thank you.
Good morning, Chairman Miller, Ranking Member Michaud,
Members of the Committee. Thank you for the opportunity to
discuss VBA's transformation efforts and the employees that are
critical to its success.
I am accompanied today by the Deputy Under Secretary for
Field Operations, Diana Rubens.
As a direct result of the support provided by this
Committee, VBA employees are completing more compensation
claims than ever before in the history of VA, over three
million in the past three fiscal years and three times the
amount completed in 2000, while increasing the quality even in
the last year by nearly four percentage points as well.
Yet, despite these efforts, too many veterans still have to
wait too long to get the compensation and benefits they have
earned and that is unacceptable.
My testimony today will focus on how execution of our
transformation plan will allow VBA to eliminate the backlog in
2015 by leveraging our greatest assets, our employees.
I would first like to discuss the inventory of claims and
the factors impacting our employees' timeliness. The current
inventory represents claims from veterans of all eras. The
largest percentage of our claims comes from our Vietnam era
veterans who make up 37 percent of the inventory and the
backlog.
1990 Gulf War era veterans make up 23 percent while
veterans of Iraq and Afghanistan conflicts make up only 20
percent. Our World War II and Korea era veterans make up less
than 10 percent.
Thirty-nine percent of the inventory are original claims,
those submitted by veterans claiming a disability for the very
first time from VA. Sixty-one percent are supplemental claims
from veterans who are seeking additional benefits. In all,
about half of the veterans in the total inventory and backlog
are already receiving some level of compensation from VA.
What is clear, is the demand for this benefit is at an all
time high. In the past four years, we have added more than
940,000 veterans to the VA compensation rolls which is more
than the size of the active duty army and navy combined.
Coupled with this increase are two factors that have had a
significant impact on the growth of the inventory and backlog.
In 2009, Secretary Shinseki made the decision to add three
presumptive conditions for Vietnam veterans who were exposed to
Agent Orange. In response, VBA dedicated 37 percent of our
staff to do these claims, over a quarter million of them,
providing $4.5 billion in retroactive benefits to 164,000
Vietnam veterans and their survivors.
While this decision was absolutely the right thing to do,
it did have an impact on our ability to keep up with new claims
coming in the door and on the aging of claims we already had.
The second factor is the increase in the complexity of the
claims themselves. There has been a 200 percent increase over
the last ten years in original claims containing eight or more
medical issues.
From 2009 to 2012, the number of medical issues inside the
claims increased, and we completed 2.7 million to over four
million last year. This 50 percent growth in medical issues is
a truer measure of the time it takes to complete a claim and it
is having a significant impact on our production and the growth
in inventory.
Given the growing demand and the complexity of claims, it
is clear that continuing a legacy approach to meet the needs of
veterans will not work.
I am happy to report today that we achieved momentum with
the transformation plan and that plan will improve how
veterans' benefits are delivered for generations to come. And
2013, right now is the year of full deployment and change.
Our transformation represents the largest single
reinvention of this organization that we have ever seen and our
focus is on managing this change while sustaining production
and improving quality.
VBA employees are key to that success. Fifty-two percent of
them are veterans themselves. The productivity of this
workforce and the accuracy of decisions are now being increased
through new national training programs and standards.
New employees attended challenge training, decide 150
percent more claims per day with a 30 percent increase in
accuracy.
Through process improvement design teams, VBA has launched
initiatives like segmented lanes, disability benefits
questionnaires, and fully developed claims. And they are
showing positive results with increased implementation.
The veterans benefit management system is our Web-based
electronic claims processing solution. We have deployed the
first generation of VBMS in January 2013 and have 25 stations
on it today.
With the integration of VBMS and the online portal e-
benefits, we have achieved an end-to-end digital filing
capability. Veterans can now file a claim online using a Turbo
Tax like model, upload their own evidence, and all within a
digital environment.
Mr. Chairman, our transformation plan, we are on track to
achieve our goals for delivering that improved benefits
delivery for veterans.
And this concludes my statement. I would be pleased to
answer your questions.
[The prepared statement of Allison Hickey appears in the
Appendix]
The Chairman. Thank you very much.
A couple of questions.
Because we only have one panel with us today, there will be
an opportunity for a second round of questioning. So I will
hold myself to five minutes, if you will put me on a clock.
The first question, to date, three ROs have been closed for
SET. I am interested in finding out what sort of training is
provided to the poorly performing ROs' management team.
You noted in career trajectory testimony that developing
employees into positions of greater responsibility helps to
ensure employees understand the various roles in the claims
process and that institutional knowledge is preserved and
enhanced.
Yet, we have been told that some management currently does
not even know the basic fundamentals that go into processing a
claim, but they are in charge of the office.
So what I would like to hear from you, and the Committee, I
am sure, would appreciate, is what training are these managers
and directors receiving when the current option of last resort,
SET is deployed to that office?
General Hickey. Thank you, Chairman, for your question. I
will start and then I will defer to my colleague, Ms. Diana
Rubens, for any further clarification.
Our Station Enhancement Training was actually a new effort
that we started this year. It was, frankly, built upon the
improvements we saw associated with our individual employee
challenge training on the courses that we put out there.
And we saw such good improvements in personnel's ability to
both rate claims at a higher speed, and at a higher quality
level as well that we said why don't we take this in an entire
station model into a regional office where not only do we
retrain from top to bottom, those people physically touching
the claim, but we also at the same time stand down for a period
of time the leadership and review and go through how to do good
work flow management, how to use all the new tools that are
available for you to do that.
We go all the way up the line into the leadership
environment to retrain, essentially reset, provide new
information as necessary to get that regional office in good
stead.
I will tell you having done it at Oakland, we saw a 27
percent increase in production and an eight percent increase in
quality. And LA is on track showing some similar early
benefits.
Ms. Rubens. Secretary Hickey, thank you.
I would tell you I think that you have largely covered it.
The key, if I understand the Chairman's concerns in particular
around workload management, the entire team has focused on
supervisors, managers, leaders of the regional office to ensure
they understand how we make sure that work is getting
accomplished efficiently and effectively with the resources on
station.
The Chairman. So that is how you train managers and
directors when an RO has been closed?
General Hickey. So, Chairman, thanks for the opportunity to
even add more.
One of the things that we have done in Oakland that we
continue to do when we are involved in a set-like training
where we are trying to help improve and boost both productivity
and quality in a regional office is we bring in the area
directors which we have done in Oakland.
The area director for Oakland actually repositioned himself
for the entire time that Oakland was going through this effort
to provide increased oversight, increased coaching, mentoring
of the leaders in that organization.
We have done the same thing in Baltimore. The area director
for the eastern area has also positioned herself in a way in
which she is providing increased oversight, very deliberate
oversight for those stations.
The other thing I will tell you that I have done recently,
and we started this process January of this year, I have now
stood up a new VBA stat process where every single regional
office has responsibility to come and sit at a table with me
for an entire day digging into their data and to their
performance challenges and to their successes.
I have ten regional offices at the same time with me. We go
deep down dive into their data. Where they have challenges, we
ask them to please produce an action plan and we assist them
with doing that.
They also are sitting at the table with other regional
offices about their size and complement and their mission kind
of capabilities where we get to share best practices, you know,
why does this particular regional office do very well, what are
you doing in that environment that we could use over here.
The third thing we have done both in Oakland, LA, and now
in Baltimore is we have sent in some folks who do this very
well in the organization. By example, we have taken one of our
best service center managers and put them in Baltimore to
really dig in and help coach a service center manager at that
level as well so they can gain from that person's experience in
another location.
And then if there is any other things Ms. Rubens would like
to add, I will----
The Chairman. I appreciate it. I have six seconds left and
I am going to yield to Mr. Michaud.
But as I prepare to yield, I want you to think very
carefully. Have any of your regional officers been a failure?
And I now yield to Mr. Michaud.
Mr. Michaud. Thank you very much, Mr. Chairman.
General Hickey, I know one of the issues of concerns that
was actually brought up by our Senate colleagues is that
information regarding the transformation initiatives and the
performance of VA's regional office is not being shared.
Is there any information that you use to determine the
effectiveness of the various transformation initiatives that
you have not shared with this Committee?
General Hickey. So thank you, Congressman Michaud, for your
question.
I also thank you for spending an entire day with me up in
Togus after your selection for this Ranking Member position so
that we could walk you through each and every one of them and
then also show you how a segmented lane looks in practice and
show you the benefits of fully developed claims, those kinds of
issues. So I appreciate that.
Let me just say I do measure, you know, the productivity
the same way I measure productivity every single day, the same
way we present to you in our Monday morning workload reports,
the same way we produce and give not just you, not just
veterans, but every American in any State that wants to look
and see how VA is doing through our completely transparent Web
site called ASPIRE.
The other thing we do is we present all of that data
through our performance reporting in the performance.gov
environment as well.
There is nothing I have that is not shared, but if you
believe that you would like me to specifically go and dig
something out, I will.
As we gain in the production, you will start seeing the
numbers that I see on a regular basis have some impact. You
will start seeing overall production as it does today, frankly.
Today we have 7,500 more claims this year than we did last year
at this time. Today we have 10,000 claims less waiting in
inventory, a small number albeit, but I have also seen a three
percent increase in our overall production across the board.
Is that big? No. But I would remind you we are making a
major reinvention of this organization change right now and our
employees are changing while they are producing and producing
at higher quality levels than ever before.
Mr. Michaud. Thank you.
Can you provide us with the information that you are
looking at in regards to your performance metrics? I do not
expect it today, but if you can provide it for the record.
General Hickey. I will absolutely do that, Congressman.
Thank you for the request. I will take that.
Mr. Michaud. And you had mentioned the ASPIRE program, but
it is my understanding that has not been updated since January;
is that correct?
General Hickey. Congressman Michaud, there is a lag in data
that somebody has to pull it all together and acquire it and
then load it into the system. There is about a one month lag
while we make sure all the numbers are accurate at that point
in time. But it is about a one month lag.
Mr. Michaud. Yes.
General Hickey. We usually are updating it by the 10th of
the following month which is when we have a majority of the
data all culled together.
Mr. Michaud. In your testimony, you talked about the
employees. The dedication of your employees' mission is
evidenced by the very low turnover rate, only seven percent
annually.
I assume that is a national average; is that correct?
General Hickey. That is, Congressman.
Mr. Michaud. If you look at some of the poor performing
sites, the Los Angeles site, the New York site, which are poor
compared to the St. Paul site or the Togus site, which are
pretty good, do you have that broken down as far as the
turnover rates in these particular areas and, if not, could you
provide that for the Committee?
General Hickey. Congressman Michaud, I do not have the
broken down ones by regional offices, but I can certainly
provide that to the Committee.
What I would like to say, though, is this up front. I have
20,000 employees in VBA that are so dedicated to this mission.
I mentioned that 52 percent of them are veterans themselves.
What I did not tell you in the opening statement is about 98
percent of them are a direct family member of a veteran.
These people come to work every single day because they are
committed to this noble mission of taking care of the men and
women who have served in uniform. So I know they are working
hard. I have been out to 36 regional offices and everywhere I
go, they tell me how hard they are working. They show me how
much they are committed.
I walk around the regional office. I see the pictures of
all of the people that they show up every single day to honor
and do their work for. They have been in mandatory overtime not
complaining but doing it because it is necessary in order to
meet this growing demand of ten years at war, of relaxing PTSD,
of opening nine conditions for Gulf War veterans, of doing the
Agent Orange, of increasing our outreach and access
extensively.
Sixty-three hundred more events we do a year now than we
did in 2008. And, by the way, in the last year, we went from
239,000 veterans we touched and talked to, to 609,000 and we
are doing a good job of that, but with it comes additional
claims.
Mr. Michaud. Yes. Thank you very much.
The Chairman. Thank you, Mr. Michaud.
Out of the 20,000 employees you have, how many were fired
last year for not doing their job?
General Hickey. Chairman Miller, I do not have that number
explicitly. I mean, I do not even know. I probably could go
find it and get it for you. And I am happy to do that if you
would like.
The Chairman. I wish you would. Thank you very much.
General Hickey. Okay.
The Chairman. Ms. Walorski.
Mrs. Walorski. Thank you, Mr. Chairman.
And thank you for your testimony this morning, Under
Secretary, for being here.
As we have listened to this story unfold, and I am a
freshman, so I have this story unfold for only the last couple
of months, but the story is about this brave warrior sitting
here in this wheelchair. That is the story. That is why we are
meeting today.
And, you know, in my little district in Indiana, I have
52,000 veterans just in my district let alone the extended
families because it is such a family issue.
And my question is on this issue of accountability. What if
you do not reach these goals by 2015? It just seems to be a
continuing story.
And, you know, I am shocked at the Chairman reading that
this was a 1994 story in his opening statement. This has been
going on and on. And I know we hear the issue that this is
about Agent Orange and this is about, you know, the Vietnam
vets and, yet, we have a disengagement coming.
We have a draw-down coming which is going to be a
significant influx of new veterans. We are opening this to
women now in combat in the next couple of years and cannot even
address women's issues now, let alone the influx of women.
What happens if you do not meet these goals of 2015? We
just continue to roll along? And where is the accountability
line drawn because the story and the face of our issue is right
there?
General Hickey. Thank you, Congresswoman Walorski, and
appreciate your taking this position on this Committee. It is a
very vital Committee to ensure we care for our veterans across
the Nation.
And I am particularly aware of the issues that you are
dealing with in Indiana. We worked very closely in Indiana with
your adjutant general who has been an enormous help for helping
us find service treatment records, find personnel records, all
of which are some of the most difficult things for us to do to
do a timely claim.
And so I want to just acknowledge his contribution and his
relationship with our Indianapolis regional office leadership
as well.
I also know that you have had a very large redeployment
over the last year and a half of Indiana National Guardsmen who
have been fighting our Nation's war, forward in the fight, as
has the entire national guard across the Nation.
When that happens and we have a sudden surge in the system,
we do have and there are implications of that. We try to work
it really hard.
And I will tell you Indiana's numbers are going in the
right direction now because we are getting a hold of that. So I
am excited about that.
We are positioned with this transformation plan built by
not just VBA, but I will tell you many of the great ideas come
from employees out there who have been looking and doing this
work for a long time saying this does not make any sense, let's
change it, let's do something better.
And so many of the initiatives like simplified notification
letter, like disability benefit questionnaires are in there
because employees recommended it. Many are in there because our
veteran service organization who I invited to help build the
plan, they are inside the planning horizon, many of them
suggested ideas that are included in here like further growing
the fully developed claim process where we have today 54,000 of
those claims we have done in 108 days because we had the help
of the VSOs who 60 percent of them represent our veterans
coming in the door.
At that point of contact when they are filling out that
claim with that veteran, they can say, okay, you are claiming
this thing, do you have a piece of medical evidence for that,
give me your DD-214, I can connect the dots. I can now give VA
your full and complete capabilities so when it comes in the
door, I am not doing that long hunt it takes us to find all
that medical evidence.
The plan we have has been measured in a pilot format inside
a live regional office with two requirements right up front. It
had to have a VSO in it and it had to have one of our labor
partners in it right up front because I wanted to know any
implications anybody saw to failure in that.
And I believe that I have the support of the VSOs on the
plan.
Mrs. Walorski. And with all due respect, I am sorry, just
because of the time, I just wanted to add, just ask another
question in follow-up here though.
But the accountability of this by 2015, if this does not
happen, what is the contingency plan because historically if
you just look at the data, it has not happened? So what is the
backup plan if this VBA does not come through like it is
promised to come through?
General Hickey. So thank you, Congresswoman, for the
follow-up question.
I will tell you historically we have never had a paperless
IT system before. We have never been in a segmented lane
process where we have an express lane where if you are veteran
with one or two medical issues, it is kind of like going to the
grocery store on Sunday. You just want a carton of eggs, you do
not want to get behind me who shops once a month and I have two
cartload fulls.
So we have a lane now where 32 percent of our claims can go
through in a much faster process. I have measured that. You can
take 100 days off those claims. We have seen it since October
for the regional offices who were in that.
I will tell you today this month, all our regional offices
will be in that new segmented lane model nine months ahead of
schedule. Why? Because I saw an increase of about ten percent
rater production because we were in those different lane
models.
And, by the way, from a people perspective, I can now
target--this gets to Congressman Michaud's idea--I can now
target really complex claims to people who have lots of deep
experience in those claims in that special operations lane we
have.
Mrs. Walorski. Thank you.
Thank you, Mr. Chairman.
The Chairman. Thank you.
Ms. Kirkpatrick.
Mrs. Kirkpatrick. Thank you, Mr. Chairman and Ranking
Member Michaud.
General Hickey, I represent a large rural district in
Arizona with many veterans and they have to travel hundreds of
miles sometimes and bear the expense of an overnight stay out
of pocket. And I have a caseworker who is devoted specifically
to taking care of veterans' needs.
Since I took office in January, we have taken in 17 cases
of veterans facing backlog. The majority of the backlog is over
two years. We have even heard reports of veterans who passed
away while waiting for their claims to be processed.
We are hearing from men and women who are stuck in the
system. They are struggling. We know their names and we know
their stories.
Ending the VA backlog is not just about boosting
statistics. It is about bettering lives. It is about fighting
for those who have sacrificed for all of us.
My question is, have you specifically looked at the
obstacles that rural veterans face in the claims process? Are
you addressing that and, if so, how?
General Hickey. So thank you very much, Congresswoman
Kirkpatrick, and I appreciate your sensitivity to our rural
veterans.
Let me tell you in this transformation, it includes a way
in which you never have to show up to an RO again to get help
from us and the way it does, frankly--and it exists today. This
is not PowerPoint. It exists today. In fact, I have had 2,000
claims without even advertising it exists today.
And that is, if we have a veteran who is on e-benefits,
that is our new DoD/VA shared portal, they can today go online,
like you all do your taxes online with Turbo Tax, today they
can go online. They can file a claim. It does not make them
type it in a form even anymore. It is a question/answer kind of
thing where they get all the information online.
They can now today upload their own medical evidence. Do
not even have to ship off the paper to us anymore. Save that
medical evidence. That medical evidence and that claim--by the
way, never before have you had the ability to save date of
claim which translates into money for veterans instantly. We do
now.
That goes directly into our new paperless IT system rather
than that veteran who has to--and I appreciate this. I commute
long times, but not nearly the distances they have to. But they
do not have to get in a car to deliver it. They do not have to
get in a car to go to a public contact center to find out what
the status of it is.
It comes right back to e-benefits and tells them on that e-
benefits site what is the status of their claim, what stage is
it in, what do we need still from them that we do not have in
the evidence that they have provided.
Not only have we created that, in existence today we have
also created the stakeholder enterprise portal because I am
going nowhere, nowhere in this transformation without the
support and help of our veteran service organizations. We have
to have them in this process.
So we have built a stakeholder enterprise portal that
mirrors e-benefits, that allows our VSOs to file those claims
on behalf of people they hold a power of attorney for and then
they can upload the evidence. And I never get the paper in the
door. So all of that exists today.
The other thing I will tell you that will help our rural
veterans, and I know you were describing, I think, more of a
situation with their health, where they go for a health
appointment, is the new telehealth efforts. And that is not my
area, but I am certainly more than willing to get you more
information on the growing telehealth efforts that my
counterparts in the Health Administration are doing as well.
So we are trying to get online. We have clearly heard from
our veterans. Seventy-three percent of them tell us that they
want us to meet them online. So we are doing that and we
provided a provision for doing that.
I will tell you my data says they have moved there. In
fact, I had 10.7 million contacts in 2010 and that was 98
percent by phone. Today in 2012, I have 31.9 million contacts,
32 percent by phone, 68 percent by e-benefits. So they are
coming up online.
Mrs. Kirkpatrick. Thank you, General.
My time is almost out, but I want to ask one other
question. Yesterday I spent time with Iraq and Afghanistan
veterans who are calling for a commission devoted specifically
to figuring out how we get rid of this backlog.
What are your thoughts about such a commission?
General Hickey. Thank you, Congresswoman.
I will tell you that I have a lot of oversight and very
effective oversight today. I have this oversight of this
Committee which I really appreciate. I have the oversight of
the Senate Veterans' Affairs Committee and I have many
Subcommittees that provide us oversight on a daily basis.
I have the oversight of the inspector general on a real
regular basis and the oversight of GAO on a real regular basis.
I believe that we have a lot of great people already looking
into how we are doing this and providing us great ideas and
also providing us challenges. And I think that the oversight
that has been presented is comprehensive and I look forward to
continuing working with the existing oversight.
Mrs. Kirkpatrick. Thank you, General.
And I yield back my time.
The Chairman. Thank you very much, Ms. Kirkpatrick. And I
also appreciate you bringing up the IAVA call for a commission
from the President to look at this backlog. I support their
efforts on that as well.
I would like to ask unanimous consent from this Committee
to allow the majority whip, Mr. McCarthy, to ask questions out
of order. Are there any objections?
Without any, Mr. McCarthy, you are recognized for five
minutes.
Mr. McCarthy. Well, I want to thank the Chairman and thank
this Committee for letting me be a part.
Under Secretary, I have a few questions, if I may. First,
let me preface with my concerns. I do not sit on this
Committee, but I am here because I have a great concern. I may
be the majority whip, but this is not a partisan issue.
And all the data that I have seen, I am frustrated that it
took frustration of Congress to have an audit to find out this
answer. I am frustrated with the direction of where we are
going, so let's walk through the GAO report.
And if we could be specific about some of the things that
we have asked to do here. I know the GAO recommended the VA
develop a robust plan for all of its new initiatives including
performance goals to keep individuals accountable from the top
down.
Do you first agree with the findings and the
recommendations?
General Hickey. So thank you, Congressman McCarthy.
I will tell you that I had some disagreements with the GAO
report and I lodged those, but I am happy to answer your
questions if you would like.
Mr. McCarthy. Okay. So you disagree with the findings?
General Hickey. I did disagree with some of the findings in
the GAO report.
Mr. McCarthy. Okay. What specific steps on the timeframe of
the VA going to take to correct the problems that the GAO
found?
General Hickey. So, Congressman McCarthy, let me just tell
you what we have already done in terms of and where we already
were in terms of some of the things that they might have found.
And so that was partly my reaction to the GAO report. Things we
already were doing were actually then further documented in the
report.
For example, we do have new performance standards that we
have negotiated with our labor partners. We will continue to
upgrade those performance standards as we move forward.
Mr. McCarthy. So you find it acceptable the number of days
in the process?
General Hickey. Congressman, no, I do not. None of us at VA
find it acceptable that there are too many days and it takes
too long to get a veteran the answer to their claim. But we are
well on our way on a path with a good solid plan vetted by many
people.
Mr. McCarthy. So this new plan of yours, when will it be
able to be finished?
General Hickey. Congressman McCarthy, we had provided that
plan to the Congress here in January. It is full and complete,
very detailed, specific milestones and the like. I did not wait
to execute on that plan. I was already executing on the plan to
make sure we did not have any daylight between when we--you
know, all the time that we had to try and fix this problem.
I will tell you right now today we are working on our very
oldest claims. As soon as we finished the Agent Orange, Nehmer
caseload, we took the people who had been doing it, 37 percent
of my workforce, we took and pointed them back to the claims
that had been waiting, our very oldest claims, over two-year-
old claims, that are right now today, and you will see it--you
know, you are probably wondering why my numbers are going up--
is because my regional offices were given direction to go do
those oldest claims.
I could have made my numbers look better. I did not choose
to do that. It was not the right and integritous thing to do by
our veterans who had been waiting. I could have made that
number look better by simply saying to our regional offices
only do new claims and then only those days would have hit that
average.
That is not the way we are with our veterans. So we are
doing old claims, two-year claims right now which is inflating
that number that you see in that average days to complete.
The other thing I will tell you is the other thing we did
was we repointed capability----
Mr. McCarthy. I know I only have five minutes and I
understand here, but I want to get to the crux of the problem.
Is your productivity in the time you have been there, has
it risen or lowered?
General Hickey. So, Congressman, our productivity has gone
to the ability to rate a million claims, a million claims,
record level, historical level for VBA in all of its history, a
million claims----
Mr. McCarthy. So let me just go to the core. If I go to
completed claims per field employee, has it increased or
decreased in the timeframe of your leadership?
General Hickey. Congressman, we have done 74 percent more
claims increased over 2000----
Mr. McCarthy. Do we have the graph here? Maybe you can
clarify. The data that I have in 1997, we were doing 136 claims
per field employee. Today that number is 73.
Is that data wrong or do you disagree with that data?
General Hickey. I disagree with that data, Congressman, and
I will tell you why.
Mr. McCarthy. Okay.
General Hickey. In 1997, I was potentially doing more
claims per FTE, but I was also at 59 percent quality, not
something anyone on this Committee wants me to ever go back to
again, not something our VSOs want me to ever go back to again.
And last year, even doing a million claims, we actually
increased our quality by almost four percentage points.
Mr. McCarthy. Then why in the LA regional office, why did
you have to do a station enhancement training where you shut
down the entire facility to retrain the staff this January?
General Hickey. Congressman McCarthy, one of the things
that we learned in setting up what is now called challenge
training for us, which is part of this transformation plan, we
did not have very good national level curriculum tested kinds
of training that we were executing prior to my arriving here.
We do now. And so we are providing that benefit to stations.
Mr. McCarthy. So is the station enhancement training, was
that not taken up because the claim process was so bad in
filling it out? I mean, why would you shut down the entire
office for an entire day if the process was not going
correctly?
General Hickey. Congressman, we wanted to make sure we gave
every advantage of every training and skill growth opportunity
to every employee in LA because I know they want to be very,
very good at helping the veterans that they serve, the families
and survivors as well.
And we did not want to just say keep doing what you are
doing. Maybe they had learned something wrong and we wanted to
correct that if there was an opportunity to do so.
Mr. McCarthy. So what is it? What was the decision that
made you shut it down for the entire day? Where did you see the
problem? Was the claims not being done correctly?
General Hickey. Where we started station enhancement
training was in Oakland to begin with. And Oakland, after going
through its station enhancement training, saw a production
increase of 27 percent and a quality increase of eight percent.
That is why I said let's go to the next station that is most
challenged.
And why we went to LA to do the same thing, we learned
there was goodness in doing that kind of training and
retraining the force, many of which who have not had the
benefit of the new challenge training.
Mr. McCarthy. One thing I have always learned. It is always
good to have data. The data that shows under this work, your
productivity is down, the performance is not there, and that
goes to the core of leadership. If you are to correct this
overall problem, it is going to take the leadership to make it
happen.
The turnover rate is too high. The process takes too long.
The correction to the problem, I think you are avoiding many of
the answers to make it all happen. I think that takes from the
leadership down to make sure this gets corrected.
And I will tell you from the instance of where I am at,
this is a core issue and this is not a partisan issue. And this
is not something that this Committee will wait to have happen.
If I had seen these numbers before, it should never take
another investigation from Congress to find these problems and
we will not sit back to have them corrected.
I yield back.
The Chairman. Thank you, Mr. McCarthy.
Mr. Takano.
Mr. Takano. Ms. Hickey, recent press articles have
highlighted that veterans returning from Iraq and Afghanistan
who live in metropolitan areas such as Los Angeles, New York,
and Chicago wait twice as long as their counterparts for their
claims to be processed.
What is being done in these urban areas to properly staff
as well as recruit and retain quality employees?
General Hickey. Thank you, Congressman Takano, for the
question.
And I know I said it in my initial statement, but I would
like to sort of reiterate it here. Of the backlog and the
inventory, 20 percent of that backlog and inventory are Iraq
and Afghanistan veterans.
The things we have done for those veterans are: you do not
need a claim done even by VBA to get immediate access to health
care. Any veteran, Iraq and Afghanistan, who have medical
issues they need to deal with can immediately go to the medical
center and get five years worth of medical care to move
forward.
And you do not have to wait on me anymore actually. After
the latest update to the 9/11-GI Bill automation, now we are
doing claims, the bulk of the work of our claims in less than
six days to keep our kids in school. You do not even have to
wait there anymore. You do not have to wait for a VA home loan.
What I will tell you in California many years ago, and I
could not even tell you which Administration it was under,
there was a decision to build a resourcing model for VBA
regional offices that essentially said if you did good last
year, you get more FTE this year.
That does not make any sense to me. We have been
restructuring that resource model. I believe it should be based
on demand. It should be based on veteran demand.
So in the case of Oakland and LA, I have actually increased
in this last year FTE in both sites. So that is one of the
things we are working through right now to sort of restructure
and redistribute our resources that this Committee and others
so generously provide us.
Mr. Takano. My colleague from California mentioned the high
turnover rate. I understand there is a high turnover rate among
veteran service representatives with one reason being that
the--well, he did not mention this, but is a possible reason
that the position is capped at GS10 level?
In terms of career growth and incentives, has there been
any effort to delineate the different tiers of VSRs to
accommodate those with more expertise and to better incentivize
VSRs to stay in their current positions?
General Hickey. So, Congressman Takano, great question and
something we have been talking about inside of VBA. And I noted
that our AFGE leadership would like us to look at that. I
talked to the AFGE leadership and I am interested in having
that conversation to see if there are better ways for us to
describe how those people do the work.
What I can tell you is I do not think many people
understand how complex that work really is. You are not just
rubber stamping a rating and saying, yes, I see it, checkmark,
there it goes. There are serious adjudication wisdom, judgment
that goes into those processes.
It is not easy to go find medical evidence. It is not easy
to find the service records for the nature and character of
your service either. And that is what our VSRs do every day.
That is hard work and it is complicated work.
One of the things I will tell you is the new VBMS system
capability. In the past, you had to remember that as a VSR, in
your head, all those different things you had to check. You had
to remember it in your head. Now in the new VBMS capability, we
are giving you tools so you do not have to remember it. It
tells you. It prompts you. It makes you look for those things
that you know you need to do.
One of the areas we get challenged with in terms of our
quality is the inferred medical conditions like, you know, you
have diabetes, but that could mean we also need to look at all
these other 13 things. We would miss those inferred things.
Why? Because somebody had to remember that in their head.
Today in VBMS, you do not remember it in your head anymore.
The minute you put that medical code in there, it immediately
populates the inferred conditions and helping a VSR to know I
need to ask for those exams, those medical exams and get that
medical information.
Mr. Takano. You mentioned the increased caseload. I had not
understood. Can you remind me just what the Agent Orange
claims, what is the significance of that addition to the claims
load of VA?
General Hickey. Absolutely, Congressman. And I will tell
you if you could see a chart that I have that I am happy to
share with this Committee, the spike that happened when we
overnight put 260,000 Agent Orange claims into our inventory,
had a significant impact. It took 37 percent, all of our surge
capability out of the workforce leaving 63 percent of our
employees to do the entire rest of the bucket.
That was a significant impact and we did them in a really
good--I know there was testimony last week in the panel that
followed me in the Senate Veterans' Affair Committee where the
person, the legal representative stated we did them very, very
well. We wanted to make sure we did them timely and very well.
Previous times we did not. They got handed back to us and
we were told to do them again. We did not want to do that.
The impact has been 260,000 claims worth in backlog or half
the backlog. It had a significant impact. But absolutely,
please absolutely know the right thing to do by our Vietnam
veterans who have waited more than 50 years for an answer for a
conditioned that they suffered in war.
Mr. Takano. Thank you.
General Hickey. Thank you.
Mr. Takano. Thank you, Mr. Chairman.
The Chairman. And, again, nobody on this Committee is
questioning opening those presumptions up one bit. But, first I
think it is important to note that VA knew that it was getting
those numbers into the system. VA did not prepare for the
surge, did nothing, and that is the concern of this Committee.
There is no surge capacity to handle another presumption signed
off by the secretary for another illness within the system.
But, I think it is also important to note you keep focusing
on the record million claims that you have been able to produce
in a year. How about the record 900,000 claims that are in the
system today? It goes both ways.
Mr. Runyan.
Mr. Runyan. Thank you, Mr. Chairman.
And, Secretary Hickey, I look forward to the number because
I know Secretary Shinseki always talks about accountability and
the number that the Chairman requested about how many people
have actually been held accountable with their job. There is a
fine threshold between being able to train somebody and someone
not being able to do their job which kind of leads to my next
question.
We always talk about training. Is it internal all this
training we do? Are you bringing people from the private sector
that do insurance claims and the like? Who sets the criteria
for all this training?
General Hickey. Thank you, Congressman Runyan, for your
question.
And let me address the first one which is, we have, like
every other agency, Federal agency and even industry, when I
was industry for three years, we used the same identical
process called a performance improvement plan for employees who
are having a difficult time meeting their quality or
performance standards.
That performance improvement plan is designed to be very
collaborative in writing, working with the employee to help
them succeed. That is the desire is to take a really good
employee, find out where they need additional help, and then
help them succeed in coming off that PIP and being a valuable,
contributing member of our organization.
So I will tell you we do PIPs all the time. People graduate
from those PIPs. Some people do not. And when they do not, we
do a couple of things.
One, we look back in their personnel record and say were
you fully successful at a lower level doing a different job and
can we offer you that opportunity to keep your passion for
veterans or families and survivors in the organization. And
likely you would not have made it up if you had not been there
in the first place. We will offer oftentimes that opportunity.
The second thing that we do look at is, we do look at
terminations and people leave us. And sometimes that is just a
fit issue. That exists in any company, in any organization
around the world.
So I do say we do have a process and that is an
accountability process that we work closely with our employees.
Mr. Runyan. From the get-go when you are hiring somebody,
though, is there a baseline threshold to even get their foot in
the door?
General Hickey. So absolutely we have requirements for
hiring. In fact, we have increased some of those requirements
of late with an exposure to the work because we will sometimes
find people think it is a different experience to come in and
do a rating claim.
They think that they are going to interact a lot with that
veteran when they are really not having that daily interaction
with the veteran. They are really working hard on getting those
claims done. And so once they get into the system, they kind of
go, this is not what I expected.
So we have done a big push across the country. So when you
are looking at a job in VBA in one of these rating
environments, that you get to come hang out and see what it is
like and talk to people who do it and get a very good feel for
this work to make sure it is a really good fit.
Mr. Runyan. But is there a competency exam or anything that
they would have to go through?
General Hickey. There is not at this point in time, I
believe a competency, again. But, I will refer to Ms. Rubens to
talk about any further of that.
Ms. Rubens. Good morning, Chairman Runyan. Yes, there is
process that we are beginning to put in place. We have been
working hard with our HR folks to say what kind of assessment
fits within the overall OPM requirements and allowable
opportunities to us to insure that we get not only those folks
that are so committed to the Veterans, but have some other
baseline abilities that they bring to us. We are building that
now.
Mr. Runyan. Ms. Rubens, I think we all get that. I mean,
everybody in this room is committed to Veterans, but,
ultimately, as leaders of the organization, you have to put the
best people in place to execute the plan. And I think that is
really where we are dropping the ball here.
Talking about this and, obviously, what we are in as
government, we are in the business of customer service, that is
really what it is. And Secretary Hickey, you brought up the
phrase, interacting with Veterans, is there any metrics in
dealing with the customer service aspect of it? How do you
measure that?
I hear the frustration each and every day of someone being
passed on to 9,000 different hold messages and being told to
call back. That frustration and the accountability of that and
how do you actually apply that?
General Hickey. So, thank you, Congressman Runyan, for your
question. And there are, in fact, we use JD Powers to assess
our customer satisfaction with the services that we provide.
Up until recently we did that primarily in our call
centers--call center environments. I will tell you that our JD
Powers score was 745, 763 is the national index for really good
customer service on a call center. So, we are not far off from
the national index for that in our call centers.
That doesn't mean it is not frustrating. I totally
understand that. It doesn't mean it is not frustrating when you
are one of the ones that are not getting through in a prompt
time.
I will tell you, we have under this transformation plan
built two additional capabilities to relieve some of that
frustration and our Veterans are taking us up on that kind of
capability in record numbers. One is virtual hold, which means
you, literally, just elect the option, you hang up the phone,
you go get breakfast, you do your piece of work, you feed the
dog, you do whatever, run a load of laundry or get ready to
work or go back to your work on your computer and we call you
back. I know it works. Ninety three percent of the time we
reconnect with you. The only reason why it isn't 100 percent of
the time is because you leave whatever phone you were waiting
at.
The other feature we now have that our Veterans are
increasingly electing is scheduled call back. And this is an
industry best practice and that is you elect a time in the next
week where we will call you at that time. I know it works, I
have done it to test the system, multiple times. It always
calls me, frankly, I'm always surprised, I forgot I scheduled
the appointment. But luckily I always put it on my cell phone,
so it finds me anywhere.
Both of those two things have helped relieve the pressure
on the calls. The other thing that has, frankly, helped relieve
the pressure on the calls is, the move from calling to e-
benefits. We have 63 percent of our contacts now happening on
e-benefits. So, they are moving from a phone call into an
electronic environment.
Because, the biggest reason they call us and you know this
and I expect it is to check on a status of their claim, which
they can now see on e-benefits.
Mr. Runyan. Thank you. I yield back, Chairman.
The Chairman. Ms. Titus.
Ms. Titus. Thank you, Mr. Chairman. And thank you for
coming to testify today. It is nice to see you again. I don't
mean to sound like I am piling on, but I have to talk about
what is going on in Nevada.
The regional office that serves my district of Las Vegas is
located in Reno, which in itself makes no sense to me since
most of the people in the Veterans are in Las Vegas as opposed
to Reno, but maybe all the computerization will help make that
better.
Also, the average time it takes to complete a claim out of
the Reno office is almost 500 days and as one of the Members of
this Committee, I think that's about the worst. I just want to
get you, maybe, after this hearing or something, to give me
some information of what is happening there to address that
timeframe.
And then two questions. One, are there benchmarks for the
regional offices or are you just going to wait until 2015 to
see if they are meeting your goals, because by then it might be
too late and benchmarks might be helpful.
And second, while this Committee is here to provide
oversight, we also want to help you to do better to help our
Veterans. Do you have any suggestions of things that we can do
to make this process of getting rid of the backlog easier or
quicker?
General Hickey. Thank you, Congresswoman Titus. And I have
been out to the regional office in Reno and I think I am headed
back out there to talk to the Nation's county service officers
here this summer, so I will look forward to seeing it again.
Let me first start by answering your Reno versus Las Vegas
question, which is, we may have the office sitting in Reno, but
we have intake sites in Las Vegas where Veterans in the Las
Vegas area can get us that information. But, frankly, under
this transformation plan that is real today, that is not power
point and made up stuff, they can go online through e-benefits,
file their claim, upload their evidence and get it all the way
into VBMS and they can come back and check on the status of it
right on e-benefits and never travel anywhere.
The second thing that I will also say is, as we have looked
at the Reno problem, part of what happened in Reno, straight
up, up front--and it has more of an impact in a really small
office like Reno is, is when you have an employee or two that
moves in a case they have had, one for family reasons to a
different State where they actually joined us in a different
regional office in a different State and another for health
reasons and when you have, you know, people who retire and that
all piles on at the same time, that creates a problem in terms
of being able to continue production.
I will tell you, Reno has moved forward in terms of its
staffing, it has got those positions being filled already. I
will also say, though, you know, a new person versus somebody
that has been there 20 years, there is a different level of
coming up to speed that occurs in that process.
What I have done--what we have done, we have married Reno
with the Boise office. The Boise office has some capacity to
assist Reno, so they are taking on those cases.
The other thing I will let you know is, it doesn't mean
every case is happening in 500 days. What Reno has been doing
for the last four months or so, is doing very old claims in the
system that I have committed them to do. So, that we can help
those Veterans who have been waiting as we did those Agent
Orange claims. So, I will allow or ask Ms. Rubens if she has
anything else to add to that discussion.
Ms. Rubens. Thank you, ma'am. I would add in addition to
some of those things that the under secretary mentioned, Reno
is also coming up in our next stat review. We will be able to
work very closely with them to dig down into what other things
we can do to support them as we look for opportunities to
insure that the Nevada Veterans are being served properly.
Ms. Titus. So, do you have benchmarks in for the regional
offices?
General Hickey. We absolutely do, Congresswoman. For not
just that, but 93 other different metrics that they have to
hit, because a regional office doesn't even just have a
compensation responsibility, it also has a vocational
rehabilitation employment responsibility. It has a loan
guarantee responsibility. It may very well have an education
regional processing office or all those----
Ms. Titus. Okay. Let me ask you something else real quick.
I know you mentioned in the Senate hearing about some deal you
have made with the Department of Defense to get information
more quickly, because right now it takes--let us see, 25
percent takes more than 60 days to get the evidence and 13
percent takes more than 90 days. Can you elaborate on that
deal? Are there some checkpoints to make sure it is working? Or
what if they don't comply?
General Hickey. Congresswoman Titus, I appreciate your
question and the opportunity to talk about this, because I
consider this a really good news, and not just the DoD
agreements, but I was also like to just share, IRS and Social
Security have made game changing agreements with us and are
already proceeding forward to make it happen.
By example, many of the claims that we have to do require
information, Social Security or IRS has that we had in the
past, only got it on an annual basis and never with a three
year back look, which is what we are required to do for a
decision in those cases.
What I have now agreement and I totally appreciate the
leadership at both of those two agencies, I am going to get
that weekly now. That fundamentally changes that piece of the
evidence hunt.
With DoD I appreciate, very strongly, my new partner over
in DoD who has been working some of these very difficult
issues. One of which is, the evidence that we use to decide a
claim, largely is owned by DoD. In most cases it is.
VHA's medical records that we use to typically do
supplemental claims, those are the second time and on cases, I
can get to those really easy. I have access into that system,
they're electronic, I electronically pull them, I don't even
make paper anymore out of them and I can just ingest them.
DoD has now given me an agreement, signed the memorandum of
understanding or stepping out forward. They've stood up cells
in the Army and the Air Force. The Navy is doing it a slightly
different way, but they are doing it. Where they are going out
and not only gathering all the medical records, but they are
now going out and getting what they've never had in the medical
record in the past, which is the Tri-care records, which is the
contract medical records.
They are pulling it all together. They are certifying to me
that they have the medical evidence in that record. And they
are signing their name on it and they are giving it to me so
that I don't have to go back and keep doing what I have, which
is you asked about legislation, which I have in legislation
since the Veterans Claim Assistant Act of 2000. I have to
exhaustively look for something that we don't own and never
owned in the beginning.
Ms. Titus. Thank you. Thank you, Mr. Chairman.
The Chairman. If I can follow on with Ms. Titus's questions
regarding your testimony last week before the Senate Veterans
Affairs Committee. You had had, in fact, talked about the
issues of getting records from DoD. I think, basically you
said, three out of five times when you have an old file, the
record issue is the problem. You further stated in your
testimony that you were bound by law to wait 60 days after
initially asking DoD before an RO can make that request again.
Is that true?
General Hickey. Thank you, Chairman Miller, for your
question. I will tell you that I have learned a little bit
more. You know, I have been here 16 months, so everyday I learn
a little bit more. The law is in the VCAA, but it doesn't,
specifically, prescribe the dates we have.
I will tell you what it does do. There are two words in the
VCAA law, one says, for everything I get that is private,
medical, all the rest of that, I have to reasonably go get it
in a reasonable period of time. In the same law it also says,
for Federal records I have to exhaustively look for all of that
evidence.
In the period following the VCAA effort, the legal--the
experts got together and said----
The Chairman. I am sorry--I am sorry. My question was, is
it correct that you have to wait 60 days by law or not?
General Hickey. It is correct that I have to do something
exhaustively searching, which is defined in law by 60 days.
The Chairman. Is it correct that you have to wait 60 days
or not?
General Hickey. It is not in law that says 60 days.
The Chairman. It is not part of the--but you said that it
was. Let me remind you that it is in your own M-21, Part 1,
Chapter 1, Section C. You can make that change, yourself. So,
it never was law, but you made it appear that legislatively it
was an impediment to you being able to do your job. In fact,
you can make that change yourself.
I would like to recognize now, Mr. Huelskamp.
Mr. Huelskamp. Thank you, Mr. Chairman. Madam Under
Secretary, you have mentioned accountability and data and
penalties. One thing I want to ask, follow up my colleagues
questions about the regional offices and your benchmarks.
What penalties do you have for those regional offices that
do not meet those requirements?
General Hickey. Thank you, Congressman Huelskamp, for your
question. And the penalty is, there are no bonuses for those
leaders. The penalty is, there is less bonus structure for big
wide, you know, RO level capability. The penalty is, frankly,
and bigger than that, the penalty is, those great employees get
up every single day wanting to be the very best regional office
in the country serving their Veterans, their family members and
their survivors and they don't feel good when they know they
have given it away.
Mr. Huelskamp. And the bonuses--you are referencing all the
employees or just the senior managers.
General Hickey. Largely the senior managers, but even in
the ranks below--G12 and below, there is a structure----
Mr. Huelskamp. And I appreciate that. Let me follow up a
question on that, would you provide for the Committee the
listing of those bonuses for those regional managers that you
provide in the last five years. Can you do that for us?
General Hickey. I can provide '11 and earlier. I cannot
provide yet '12, because the Secretary has not finalized his
decision on those bonuses.
Mr. Huelskamp. For fiscal year?
General Hickey. '12.
Mr. Huelskamp. '12.
General Hickey. They are still working on it. The Secretary
has not finalized his decision on those.
The Chairman. If gentleman would yield for just a minute.
Mr. Huelskamp. Yes, sir.
The Chairman. I believe that out of 57 VBA SES employees
that were evaluated in 2011, 30 received a performance award. I
don't know who. Out of those 30, the awards ranged from $7,372
to $23,091.
Mr. Huelskamp. Pretty substantial. If you would follow up
then, provide additional information on the regions that those
folks served in, so we can match those to possibly past
benchmarks.
But, one other question that I think is fundamental here is
the issue of data. We heard from the GAO last week that in
certain parts of your agency that there is data falsification
occurring. And can you tell me how many employees in your
division that have been penalized or punished for falsifying
data in the last three to four years?
General Hickey. So, Congressman Huelskamp, I don't--I am
not aware of a data integrity problem in my regional office.
So, if you have something specific you would like me to
address, I am happy to, for the record.
Mr. Huelskamp. Well, you might look at the GAO report, we
discussed that and according to VA Table of Penalties, Number
26 deals with falsification of data and it is still waiting for
a response from the VA, because this whole approach and the
benchmarks and all your discussion here, is centered on
accurate data. And if we have employees that are actually
falsifying data, whether it is in your division or others as
well, ma'am, you would agree that our whole discussion here is
for naught if we have inaccurate data; is that correct?
General Hickey. So, Congressman Huelskamp, I will take your
concern back, for the record. I believe someone----
Mr. Huelskamp. No. I asked you a question. Do you think
that this discussion here is data driven and if there is
falsification of data as the GAO has outlined that lends little
credence to the arguments here about benchmarks and progress.
General Hickey. So, I care starts with integrity and I
believe that everything that we do comes from a point of
integrity first.
Mr. Huelskamp. Okay. So, will you provide and look at--find
out if there have been any penalties or folks have been finding
falsified data?
General Hickey. I will take that for the record,
Congressman.
Mr. Huelskamp. Okay.
General Hickey. I don't have the data.
Mr. Huelskamp. Okay. I appreciate that. One other thing
about data and I apologize, Mr. Chairman, I am trying to get
information here, I will re-ask my question. And maybe you can
provide that, because apparently budget experts hire levels of
the VA have yet to find out answers, I think, to about 20
different questions about VA conferences, lavish expenditures
and travels that have been an issue for months that apparently
the VA cannot find the data for that. Apparently, they can find
data here, they can't find data for numerous other things we
ask, so have you been asked by your superiors to provide budget
information or is that someone else's responsibilities to
decide how you spend money on conferences and those types of
expenditures?
General Hickey. So, Congressman Huelskamp, I will tell you
inside of VA and VBA we are scrutinizing every single
conference, we are doing down to the paperclip. I have
mentioned before our challenge training, it is an eight week
long course. It is an intensive course where we bring our folks
to. It is probably my major investment in terms of training in
that level.
Mr. Huelskamp. Where does that training take place, ma'am?
General Hickey. It takes place largely in the Baltimore
Academy, but when I exceed the Baltimore Academy's capability
for classes, I will centralize a class close to where we have a
large population of people who are attending. I will also tell
you I have tested one time and so we are looking closely at it,
whether I can reduce the cost of that challenge training by
seeing if I can do more of a blended learning option.
Mr. Huelskamp. I am out of time. I appreciate that. I was
just trying to get some data from your superiors and it is very
difficult to provide an oversight, to actually be able to trust
the VA when they refuse to answer questions on basic budget
data and I look forward to a response from your superiors.
One last question, if I might, Mr. Chairman. You mentioned
old claims of two years. What's the oldest claim you have
sitting in the system and can you provide that information or
the range of claims older than two years?
General Hickey. I can. I can tell you 4.1 percent of my
backlog is older than two years. I can tell you that my oldest
claim is in a regional office that is ten years old. I can tell
you the reason it is ten years old is because a new claim was
filed in September of last year and when our raters were going
through it, noticed that ten years ago that veteran filed for a
condition that had one of those inferred things that we could
have found and we did not see it then. And they did not appeal
it or anything else, but we saw it and so the integritous thing
to do was for us to say, we have to, got to give that guy ten
years back capability for that claim they filed but didn't even
know--didn't even recognize we didn't even do ten years ago.
We own that time, even though it came in September of last
year. We say we are responsible ten years ago for the mistake
we made.
Mr. Huelskamp. Thank you, Madam Under Secretary. I
appreciate that. I yield back my time.
General Hickey. Thank you.
The Chairman. Mr. Walz.
Mr. Walz. Well, thank you, Mr. Chairman. And General
Hickey, good to see you again and thank you for being here. I
am sorry I left for part of the time. We were actually over
voting in the AG Committee on regulating credit default swaps
and derivatives, so I'm actually optimistic here on this side
compared to there.
But, first and foremost, I am appreciative of your service.
I am appreciative of the Chairman and the Ranking Member for
not giving an inch on this issue. For understanding that those
folks that are sitting out there, this is the issue, it is
critical, it is about our moral responsibility. It is about our
national readiness and you of all people know that, General
Hickey, so I thank you.
I am not going to defend what we haven't been able to get
done. I do want to submit a letter from the VFW to the record
that I received today. This is one quote from that that I would
say. ``The VFW believes Ms. Hickey's an integral part of the
solution to finally breaking the backlog that this and previous
administrations in Congress has helped create by under funding
the critical areas of automation and staffing.''
When I hear about accountability, every one of us who is
here, whether we got here in this last election or before that,
are part of this. So, I am at the point now, there aren't a lot
of questions asked that haven't been asked. There is not a lot
of things.
It is going to become what that outcome looks like and how
we get there. And so, I trust these folks that are sitting
there. I trust the VFW, I trust IAVA and the folks who are
here. They are pressing us and they are on your side to get
this done. Now we have got to be on their side and break it and
get this done, get the results.
If this is a case of asking for this, there better be the
courage here, whether it is taking it from somewhere else or
doing it, if it is a funding issue, put the dang money in and
get it done. If it is a personnel issue, put the personnel in
there and get it done.
But, sometime within the coming months, this thing has got
to be broken. We have got to be--and I am optimistic, I say
that not in jest now, I am optimistic we can get there. I am
willing to put myself on the line and tell them, because these
folks are saying, I have been here a lot of times. I have sat
in this room for ten years, you are putting yourself and
saying--if you want accountability and the people who said, you
know, we need accountability, it is going to start with this
side of the table, too, of holding it to that.
So, I have a couple questions though, trying to bring some
of the things that I know on this. We keep talking about you
are going to train these folks up. I am an educator. Who writes
the curriculum for training?
General Hickey. So, thank you, Congressman Walz, for your
question. I will tell you the curriculum developed now in the
new challenge training is written by experts who know how to do
this. It is written and informed by a compensation service who
watch and tracks the errors that are committed by our
employees. It is written and informed by our star accuracy team
who evaluate our claims in a statistically valid way, are the
ones that give us that overall claim quality. But now also are
measuring our individual medical issue quality, which by the
way, as of right now is at 95 percent across the Nation.
Mr. Walz. Who teaches the class?
General Hickey. They are taught by our subject matter
experts from across the Nation in previous days. I will tell
you, I just hired 40 new dedicated people who will be trainers
for this project.
Mr. Walz. As an educator subject matter is critically
important, but I would argue the art of--are they trained in
differentiated delivery of education? Because are you going to
give the same class to the four year processor, the seven year
processor, the nine year processor, the high achieving, the low
achieving. How are you differentiating how you are delivering
this training?
General Hickey. So, great question, Congressman, and
probably we have some room to grow in that area. We are doing
it by an adult learning methodology. We are doing it with a
lives claim building, while you are doing it. Which, by the
way, the live claim is actually helping production while you're
in training.
We probably need to look at and I will take that as an idea
and I appreciate your idea on that. We probably need to look at
better differentiation training. We do do that between
positions. We probably need to look at how do we target
individual ones.
I will tell you, I would be better position now in BBMS,
better position now as a result of now measuring our medical
issue level quality to with precision, down to that individual
employee. Not even how many years they have had it. To be able
to say this error is the one you always keep doing, let us help
you fix that.
Mr. Walz. What if they don't? Going back to Chairman
Miller's question.
General Hickey. If they don't, we do what we do with every
employee--what industry does with every employee, which is, we
have a performance improvement plan process.
Mr. Walz. The big question here is, you sit in front of us,
you will sit here again, General Hickey. If we come back in six
months--or let us give it a year. If we come back in a year, is
there significant change to the positive?
General Hickey. There is significant change already,
Congressman. I have 25 stations on VBMS today, that means the
minute you go live on that system every single claim coming in
the door and we take in 100,000 month nationally. So, that
means half of those, 50,000 claims coming in right now are not
turning into paper, making us inefficient and ineffective
adding to 5,000 tons of paper our employees touch every single
year.
Mr. Walz. Do you blame those folks behind you from being a
little skeptical?
General Hickey. I don't blame anybody, but I will tell you
why I am convinced today we can do it. I am convinced because I
have just seen us do it in the longer term solution for our
education claims, where we are now doing 95 percent of our work
in less than six days. That tells me if you can take, with some
automation, in the system, you can take and break that work
down better, if you can change the processes to do that better,
then you can achieve a fundamental growth.
February, last year, I had 200,000 education claims in
inventory and you all were talking to me about that and you
needed to be. Today I have 43,000 claims in the inventory for
education claims for the spring semester. Twenty five percent
of what we had last year. That is the same thing we are trying
to parten--not trying, we are committed to parten to get the
rules based automation into VBMS. It doesn't take an employee
out of the process, it simplifies that work for that employee.
Mr. Walz. I yield back. Let's do it.
General Hickey. Thank you, Congressman.
The Chairman. Thank you very much. I was handed a note just
a second ago. You may actually have a claim out there and I
don't know if this is real or not, but a claim that may be 11
years old in the Jackson office on a remand.
General Hickey. Congressman Miller, I'll have to go take
and look it up. I am happy to do that if you give me the name
and the contact information.
The Chairman. It came into us on our Web site. Let me ask
real quick, following up on Mr. Walz' question, have you been
told by employees that any management is taking actions like
ordering the processing of certain claims first in order to
make the numbers look better than they really are? Or,
accidentally clearing old claims for station credit before they
are completed and then reestablishing the claims under a 930
end product, which is not tracked by the central office?
General Hickey. I am going to have to ask my colleague who
probably knows far more about those level details than I do at
this point in time, Ms. Rubens.
Ms. Rubens. Thank you, ma'am. Chairman, I think I heard the
first part of that was being directed by supervisors or
managers to take action like that and I would tell you that I
believe the answer to that is no. We don't have any----
The Chairman. I didn't say that management is taking
actions like that, but is management doing that?
Ms. Rubens. I don't believe that we would have any managers
that would do that. General Hickey had a bit of a conversation
about integrity. It is critically important to us. I would tell
you that the 930 end product that you referred to is an end
product that if there is a mistake that has been made in
processing a claim and the end product or the decision is made
and yet there is something else that we need to do to take care
of that Veteran, they will utilize that as a means of doing
that without, if you will, inflating the credit that we've
taken and yet allow us to continue to track and insure that
Veterans are being fully answered on any number of medical
issues they provide us.
The Chairman. I will do a follow up to you for the record
on that, because I would like to know a little bit more. Mr.
Coffman.
Mr. Coffman. Thank you, Mr. Chairman. Secretary Hickey,
first of all, thank you for your service to the United States
Army and your career.
As a first Gulf War Veteran and as an Iraq War Veteran, I
can't express my concern enough for this extraordinary backlog
in VA claims and it is simply not fair to those who have served
this country and made tremendous sacrifices in defense of our
freedom.
At one location, the ONI Oversight Investigations
substantiated through the Veterans Administration's own
documentation that for many days in a row over a period of
weeks, dozens of claim raters had no claims to rate. How is it
that with the backlog such as it is, raters have no claims to
rate?
General Hickey. So, thank you, Congressman Coffman, for
both your service, as well as your question. You know, when you
go do some good things you learn some lessons and one of the
things we learned is, we started moving claims in that express
lane a whole lot faster than we thought we could.
So, we have taken some action to--and, frankly, cleared it
out too fast. That is a positive from a transformation
perspective because that's 30 percent of our claims right
there. But, what we have learned is, we need to do something to
adjust the number of people who are making those claims ready
to rate in that lane, so that there is a constant feed. And we
have done that. In fact, we have directed out in the regional
office while we look at better ways to even do this, that we
get some assistance in people helping to build cases ready to
rate.
Frankly, fully developed claims will help that. Our
partners in the VSO's who I am just so very pleased, they are
taking a very strong leadership in this realm. The more they
bring in fully developed claims, the less of a burden it is on
that VSR to move it forward and then I can move more forward in
that regard. And I have promised the VSOs if they bring me
fully developed claim, we will put it down that express lane.
That will solve for some of those problems as well.
The other things--so, as we are learning, we learned that
we are rating claims faster. There are some tools now in VBMS
that used to be an initiative called, Simplified Notification
Letter that help our raters rate many more claims than they
ever did before.
So, as we gain advantages in a part of the process, we are
looking at what the second and third order effects are through
our government structure, through our subject matter experts
and we are making adjustments as we speak, because no plan on
its face, ever goes in a way in which you don't learn something
as you go along.
Mr. Coffman. And according to the Veterans Administration
in fiscal year 2012, 185,169 rating related claims were
returned to open status for various reasons. In a particular
regional office, the Oversight Investigations Subcommittee
investigated and on a given day there were more than 150 claims
labeled as ready for decision, but they weren't ready to be
rated because they hadn't been properly developed. The claims
were then denied or sent back to open status. Is this a
training problem? Deficiency?
General Hickey. So, I will say one brief thing and then I
will ask Secretary Rubens to address the details of your
question. And the one brief thing that I will say is, Veterans,
like me, I did it to us in 2007, send in a claim and they
worked my claim for many, many months and they got ready to be
done with my claim and I suddenly realized I could have filed
for that and I sent something new in. That will take it back
out of that ready for decision process, back into the awaiting
development effort and back into gathering evidence because
they now have to get the evidence on that specific medical
condition I just claimed. So, sometimes it is that issue, but I
will defer to Secretary Rubens for her comment.
Ms. Rubens. Thank you, ma'am. I would say you have got it
just about exactly right. What we will endeavor to do if we
have to return something to an open status is, if there are
issues that we can make payment on, we'll work to do that. On
occasion it will also happen if there is a question about a
piece of evidence that a rating specialist who has got much
more technical knowledge is looking for additional information
or clarification on and so that exchange, if you will, is what
allows us to understand what is going and we continue to work
to ensure that if there are training issues, we identify those
an address those.
Mr. Coffman. Under Secretary, give me a specific number as
to what you would expect the backlog to be a year from now in
terms of what you see as the success of your leadership?
General Hickey. Congressman, I can tell you that in 2015, I
will have no claim in our hands in 125 days and we will do them
at a 98 percent accuracy level.
Mr. Coffman. One year--one year from now?
General Hickey. I don't have that number with me, but I'm
happy to provide that to you.
Mr. Coffman. Thank you, Mr. Chairman. I yield back.
The Chairman. Ms. Brownley.
Ms. Brownley. Thank you, Mr. Chair and thank you, General,
for being here. I wanted to sort of follow up on understanding
that we are sort of in the middle of this transformation
process and it is clearly a challenge, I think, to determine
staffing levels that are currently adequate and certainly
staffing levels that will be sufficient in the future. The
Chair talked about planning ahead and surge capacity, et
cetera.
In our Health Committee last week we examined the issues
around physician staffing and staff planning and trying to come
up with a data driven method of determining what those staffing
levels need to be. Is there something similar going on, on the
benefits side?
General Hickey. So, thank you, Congressman Brownley, for
your question. I will tell you, the--we have been looking at
the staffing issue. I think I described earlier in the hearing
here, but we had a resource allocation model that, frankly,
from my perspective doesn't make any sense.
I think that our resource allocation model ought to be
built on the demand of Veterans. It ought to be Veterans
centric from that perspective. This resource allocation model,
years ago was established, and so we are in the process of
redoing that now. We are looking at what is the right mix of
VCRs to raters, in this new environment? That is important to
note, too, because the nature of the work will change in a new
transformed VBA. What is the right mix of VSRs to raters? Is
there a new structure? Is there a new career ladder that needs
to be built into there to allow us to move forward?
And I still do believe--so, we do have a--the answer to
your question is yes, we are looking at that right now. I don't
have a clear defined answer for you right now because we are
thrashing through it as we speak.
Ms. Brownley. Thank you. And I wanted to follow up on
another issue. We have talked a lot about the productivity
metric and certainly that is a quantitative measurement that
can be easily measured and can be interpreted differently.
But, you have mentioned several times in response to some
questions about quality metrics and I am not sure what those
quality metrics are. I am interested to know what they are and
how you are measuring them and how they also fit into your
goals.
General Hickey. So, I appreciate the opportunity to share a
little bit about that, because we have made some changes in the
last year, though I will not change the numbers out there. I
will keep it all exposed, all the existing numbers, but I want
to further inform the dialogue.
Today--today--well, actually, yesterday, an employee in VBA
was rated, no matter how many medical issues were inside that
claim, they were rated on a up or down complete zero or 100
percent, did I get everything right in the claim?
And with an increasing number of claims that are in that 16
range--16 distinct, unique medical issues inside that claim, if
they did 15 right they didn't get credit for the 15 in their
quality, you know, they got no credit for that, which was a
disincentive, frankly, to picking up a claim that had a lot of
medical issues in it.
So, what I have done is--I agree with our folks in the
field and I heard a lot from our bargaining unit employees on
this issue and I heard a lot from our staff on this issue. It
is not a really good reflection, frankly, from a Veteran's
perspective, it is not a really good reflection of our quality.
They want to know, how do I do on these? How do I do on
backs, how do I do on PTSD and TBI and eyes and ears and all
the--the 800 diagnostic codes we do. So now, I have instructed
the staff and they have done it. We have rebuilt the systems to
allow us to measure medical issue level quality all the way
down to the employee. I could do it at the regional office
level since October of last year.
I will tell you, looking at medical issues that way, from a
quality perspective, I have 11 regional offices today that are
already at 98 percent quality. I have half the regional offices
at 95 percent quality. I have all but two regional offices
above 90 percent quality. I have two below that, we are working
hard on them. There are some of our opportunities for our set
training, to improve that capability. But that's a
fundamentally, I think, more accurate way of looking at how we
are doing it and, frankly, informs our training better.
Instead of training to all, as we do today, I can train now
moving forward to that individual employee or that regional
offices area of challenge under a medical issue. So, that is
where we are focused and where we're driving. But I will always
leave the claim level quality up there so that everybody knows,
you know, that is where--how we define it from a claim
perspective.
I just want to inform the medical issue discussion.
Ms. Brownley. Thank you, very much.
The Chairman. Mr. Bilirakis.
Mr. Bilirakis. Thank you, Mr. Chairman, I appreciate it
very much. Thank you for your service, General, and your
continued service.
In my district office I have several case workers that work
specifically on veterans' benefits. I hear often from Veterans
who are frustrated by the generated letters they receive from
the VA on their claims, listing out of date timeframes. They
receive letters stating that a claim should be complete in 180
days when oftentimes it is taking a year and a half.
They want to be able to plan accordingly while they are
waiting for their claims to be processed. In other words, they
would like to have some certainty, particularly during these
troubled economic times. Since it is the 10th anniversary of
the Iraq war, and a new generation of Veterans are entering the
system, what is being done to ensure that the timeframes are
accurate? And if the timeframe is not accurate, are Veterans
being contacted with an updated estimation as to when the claim
will be processed?
I know it is very, very important. We have to give them
hope, but I don't want to give them false hope, either.
General Hickey. So, thank you, Congressman Bilirakis, for
your question. We are doing some things and I do know we could
do better. We could do better.
So, we are trying in a couple of areas. First of which, if
you have and e-benefits account, you are actually getting the
regional office number updated on a regular basis. It feeds
right from the data system that tell you how many days you
expect your claim to take in that regional office.
It will be inflated right now as I am having folks doing
the to old claims right now. Those are hitting the average, but
it will at least give them some level of that.
Second, I know the letters. We create a lot of letters and,
frankly, there's a whole group of people who have asked us to
quite sending letters and start sending something to their
email box or put it on their e-benefits account. So, they will
know, you know, what--they will have a letter, they will have
it electronically, they won't have it in paper.
VBMS is doing something to help us on the letters, because
we create so many of them. We are doing things to try to
improve those letter, to improve the readability of those
letters, to simplify our language in those letters, to quit
talking lawyerees and talk instead human beinease and getting a
clear, concise language in those letters moving forward.
Mr. Bilirakis. Thank you. Second question, Mr. Chairman. In
the St. Petersburg Regional Office, claims development is the
largest delay with 67 percent of all claims awaiting evidence.
What is VA's strategy to address such a deficiency in evidence?
If you can answer that first, please.
General Hickey. I absolutely can and thanks for asking the
question, Congressman. Largely, the evidence that VA needs in
order to decide a claim is not owned or generated or held by
VBA, you know, over its lifetime. And it is largely--we need a
couple of things. We need medical records that includes the
ones while you were in your service to this country and this
Nation. And we need the character and nature of your service or
your personnel records. Those are the two big chunks you need.
We also need--and we'll go get it, private medical records.
We actually like to ask our Veterans and it provided a means to
do that with something called, a disability benefit
questionnaire, where they can literally hand it to their
private doc and ask them to fill it out and get it back, which
gives us exactly the medical evidence we need.
We are seeing an increase in DBQs utilization, thank you.
I'm sorry. But we need to do more, especially with private
docs, using those DBQs. That will help us with the evidence
gathering.
But the most important game changer on this was three
actions that I've had as of January of this year. Social
Security and IRS are now giving us not access to their data
once a year, access to their data on a weekly basis. That will
help us immensely.
DoD has now a new process they have agreed to with me. We
have a signed memorandum of understanding where they are now
stood up cells in the Air Force and the Army. Navy is doing it
slightly different, but the same concept. They are gathering
all of the DoD medical records. Now, to include tricare records
and contract medical records, things we have a hard time
getting a hold of. They are gathering all that up before a
servicemember departs service, either separating or retiring.
They are certifying it is 100 percent complete as of date and
they are handing it to me. That has a major game changing
effort on that awaiting development, awaiting evidence bucket.
We then will be able to, in a much faster way, rate that case,
get that decision done and move forward.
And, by the way, rate that case and do all those other
actions, electronically, coming in the door to VBMS, because
that will be a new claim. We will scan it, we will ingest it,
it will go directly into VBMS and move along and be done
without paper.
Mr. Bilirakis. I have one last question, Mr. Chairman, if I
may? Thank you. By itself, this Saint Petersburg Regional
Office has stated that it would need almost two and a half
million dollars in overtime funds in order to meet the fiscal
year 2013 production goal. How will the VA address this need?
General Hickey. I will let my colleague, Secretary Ruben
answer the question relative to overtime management.
Ms. Rubens. Thank you, ma'am. Congressman Bilirakis, we
every year have a set amount of money that we will look at to
distribute as overtime dollars. The Under Secretary mentioned
earlier the opportunity to utilize mandatory overtime to ensure
that we are getting the best output from across the entire
workforce. It is a difficult decision to make and as we do
that, it is about the volume of people that we have and the
amount of work. Looking to maximize the output, we will
continue to work with the St. Petersburg Regional Office,
obviously, to insure that they are getting the best outcome for
the resources we have to make available to them.
Mr. Bilirakis. Yeah, I would like to follow up with you on
that----
Ms. Rubens. Absolutely.
Mr. Bilirakis. --specifically, the St. Pete Regional. Thank
you, very much.
Ms. Rubens. Happy to do so.
Mr. Bilirakis. I yield back, Mr. Chairman.
The Chairman. Mr. O'Rourke.
Mr. O'Rourke. Thank you, Mr. Chairman. General Hickey, I'd
also like to thank you for your service and wanted to bring to
your attention a case that we handled in my office recently. We
had a phone call from the wife of a terminally ill veteran who
had a service related disability. She wanted our help in
expediting the claim that goes through the Waco Office and we
were able to help expedite it, but by the time that they got
the information back on the claim, unfortunately, her husband
had passed away. And at that point, the claim had been
outstanding for 450 days.
When we dove in a little bit deeper, we found that the
average out of Waco is 439 days and 80 percent of all
outstanding claims are over 125 days. And so it is important
for me to hear and more importantly the Veterans in El Paso and
the region around El Paso, to hear how you plan to address
this.
And I appreciate the ambition of getting to all claims
under 125 days by 2015, but it really seems that there is a
crisis in that Waco Regional Office and talking to the other
Members of Congress whose communities are served out of that
office, I sense that urgency from them as well.
So, we would love to have your comments on that and how we
plan to address that.
General Hickey. Thank you, Congressman O'Rourke and I will
tell you just straight up front, we actually are activating
some plans in Waco and I will let Secretary Ruben address that,
but I want to talk to you first about--and I think this is an
important venue to do this, because I could use your help in
this regard. We do prioritize terminally ill, Medal of Honor,
former prisoner of war and homeless cases.
So, please, if you ever--if you ever have anyone that falls
into any of those categories that is having a difficult time,
we do prioritize them. Sometimes people don't tell us the word
terminally ill and so we don't know that, but as soon as we
do--I have literally moved cases in a day. We have stopped all
kinds of work and gathered a whole team around to move that
claim in a day to try to beat the terminally ill veteran's
passing.
We do have ways to help that widow with a claim that is
open afterwards and I'll defer that and the status of the Waco
Office to Secretary Rubens.
Mr. O'Rourke. Thank you.
Ms. Rubens. Thank you. Thank you for the question. Waco was
one of our last Nehmer Regional Offices to come off the
rejudication effort.
What we did when we completed those rejudication claims is
that brokering center, that surge capacity, turn them first to
their local regional offices and so the Waco Regional Office
has benefitted from that.
The other thing that I think has made a tremendous
difference for the Waco Regional Office is the arrival of a new
director there. And, in fact, since last year, the inventory is
down almost ten percent. The rating accuracy has begun to climb
and as we see in the three month rolling average, that they are
now just about at 95 percent.
And so, while we are focusing on our oldest claims, causing
that average days to complete number to rise, we are seeing an
increase in the quality and a decrease in the inventory. We
will continue to work with Waco to insure that the Texas
Veterans' needs are met.
Mr. O'Rourke. I appreciate that and I have spoken to, as I
mentioned earlier, some of the other Members of Congress whose
districts are served out of that office, Congressman Flores and
others, and talked about periodic visits to the Waco Office to
meet with the regional director and find out what we can do out
of our district offices and General Hickey, you mentioned that
it is helpful to you and we can notify you of those cases that
need to be expedited, for example, with terminally ill
veterans.
I heard you, in answer to a previous question, talk about
the need for VSO's to prepare claims that are ready to go. What
else can I do out of our office in El Paso to help these
Veterans who are waiting, obviously, far too long to get a
response back?
General Hickey. So, Congressman O'Rourke, the Texas
Commission is doing a lot to help us. The Texas Commission for
Veterans. They have come together to help us create those fully
developed claims, to pull those in, to give us, you know, some
assistance in getting all the evidence gathered from a veteran
who is filing.
And I appreciate that as much as I appreciate all our VSOs
really leaning inside the wire or the fence and really doing
yeoman's work to help us significantly.
So, the things that are critical to our doing a claim,
bottom line, are the evidence that we need to make the
decision. Private physicians in the State of Texas and their
increasing willingness to complete a disability benefit
questionnaire, which has been created to capture, explicitly,
the medical evidence we need in order to make a decision.
A private physician rolling in and helping their patients
who are veterans would be a major lift in the State of Texas
and something I'm asking for across the Nation is a private
physician engagement in this area.
Mr. O'Rourke. Great. Thank you. We look forward to working
with you on that.
General Hickey. Thank you very much, Congressman.
Mr. O'Rourke. I appreciate your answers. Thank you, Mr.
Chairman.
The Chairman. Under Secretary, in your written testimony,
you included information on individual employee incentives.
While you said that at the heart of the performance award
program is a foundation focused on quality, you went on to say
that the criteria for performance are determined locally and
vary by office.
AFGE wrote in its statement that in practice, management
incentives are almost always based upon production alone and
production is always highlighted since there are several
different production categories for a station to qualify for an
award.
So, my question is this, how is high level quality mandated
for incentive rewards if there are no national criteria?
General Hickey. Thank you, Chairman Miller. I will tell you
that I value--I highly, highly value my relationship with my
labor partners. They help inform us of good ideas. In fact,
many of our labor and our employees, bargaining unit employees,
have created some of these really good ideas that are already
showing merit for us.
I will say----
Mr. Chairman. I apologize, but my question----
General Hickey. --to answer your question, specifically----
Mr. Chairman. --ma'am, my question, very simple. How is
high level quality mandated for incentive rewards if there is
no national criteria?
General Hickey. There is, Congressman, national criteria.
There is a national quality standard every single year. There
are also at the Regional Office level, while there might be
variance, it is not below a basic standard. They may have
increased in that particular locality and may have locally
negotiated an ability to hold people to a higher standard. But
there is no negotiation of a standard lower than the basic
national standard.
The Chairman. So, I am to believe that AFGE would negotiate
a higher standard for their employees than what VA would
request?
General Hickey. There are local level negotiations that do
exactly that, Congressman. And I will defer to Secretary
Rubens, who has more experience on that.
The Chairman. No, that is enough on that question. I
appreciate it. In December of 2012, which was just a few months
ago, claims processors' and raters' performance standards were
changed; is that true?
General Hickey. That is correct, Chairman.
The Chairman. Were the employees notified of that change?
General Hickey. I will ask Secretary Rubens to talk about
the strategy for that.
The Chairman. Just yes or no. Were they notified?
Ms. Rubens. Chairman Miller, yes, they were notified.
The Chairman. Okay. I have been told they were not. And so
my question is, if they were not, how can unannounced
productivity changes impact productivity? I mean, I would hope
that you would, but I've been told that they weren't.
General Hickey. So, I would tell you that the AFGE were
integral partners in the teams that developed the new
performance standards that were released in December. As we
released those, stations were asked to inform all employees. We
are, as we continue down the path of implementation----
The Chairman. Can you tell me, how do you inform all
employees? How does that work?
General Hickey. I provide the notification to the regional
offices and require and ask that they have group meetings with
their entire service center. That the teams have meetings and
that as individual employees get the new standards, they are
effectively provided with a form on the top that they will
sign, along with their supervisor, to insure that they have
been discussed recognizing that there was a change. We want to
make sure that everybody is aware.
The Chairman. Good. So, it is documented that those changes
were noticed to each employee?
General Hickey. Yes, sir.
The Chairman. Okay. Thank you. Mr. Michaud.
Mr. Michaud. Thank you very much, Mr. Chairman and to
follow up on something the Chairman mentioned about looking
further ahead at the surge. Are you able to take care of it? I
remember Paul Sullivan telling us that when he was over at VA
he tried to get the Secretary to put more emphasis on VBA
because of the surge they were seeing from Iraq and
Afghanistan, and that wasn't done.
And I know, Mr. Chairman, Mr. Walz and I have been talking
about some long term planning within the VA. We will talk to
you afterwards about how we might be able to look out five,
ten, twenty years.
My question, General Hickey, and I will try to phrase it in
a way so that you can answer it yes or no and my last one to
allow you to elaborate. In part of my opening statement, I
talked about claims as well as medical conditions, which are
different, and how you can quantify that.
Is it my understanding that you are willing to look at
medical conditions versus claims and move that through the
system since it will all be electronic?
General Hickey. Congressman, not only willing to look at
it, I think it is a great idea and it is part of our 2015 focus
is, what we call Centers of Excellence.
Mr. Michaud. Okay. My second question: we saw a chart
earlier when you look at the productivity of an employee, when
you look at claims, you can have one claim that counts as one,
but within a claim, you can have 13, 14, 10, 11 different
medical conditions. So it's more complex. Can you provide the
Committee, if you have the information available, as far as the
productivity of an employee as it relates to the medical
conditions versus the claims?
General Hickey. Congressman, I am not sure if I can do that
yet, but I will try. I will see if we can do that level of
productivity look. I know I will be better able to do it when
we are in VBMS than I can do today. But, I will look and see if
I can, and if I can, I will certainly provide it to the
Committee.
Mr. Michaud. Yes, because I think that's very important.
Sometimes the numbers might not bode out as how productive you
are or not being.
Also, getting back to my original comment, when you look at
some of the worst sites that we have in the system, whether it
is Los Angeles or Nevada compared to some of the better sites,
Togus and St. Paul.
Since the system is going to be electronic, are you going
to be looking at medical conditions and having some of the more
excellent sites, such as Togus, and St. Paul, deal with the
more complex medical conditions and than have some of the
claims that are not complex to at the poor performing sites?
General Hickey. So, Congressman, that is a great question
and this is exactly part of the look that we are taking from a
strategy perspective. And I say it this way, by 2015 when we
are completely paperless and we will be completely paperless
earlier than that. But by 2015, we will have the availability
to know at the medical issue level who are the best people
across the country that do TBI, that do PTSD, that do knees,
that do diabetes, that do Parkinson. And we will be able to,
not by what we do today, pack up a whole bunch of big, thick
claims, put them in a box, put a whole bunch of effort into the
things that have to go in there to make sure we are tracking it
right, mail it, check it in, put it in another place in the
regional office, we won't. Today, 25 stations can move work
around between themselves by pushing a button and it is
brokered.
Mr. Michaud. So what are you saying? We can adjudicate
numerous medical conditions simultaneously, in VBMS?
General Hickey. It is part of a strategy, going into a
paperless environment, is to see what the--if we have the art
of that possible and we are capable of doing that and going
faster as a result of doing it. And a higher quality as a
result of doing it. It is an equation for me.
Mr. Michaud. Looking at testimony over on the Senate side
from the DAV last week, Joe Violante had a lot of praises for
what VBA has been doing, even though they are frustrated with
the backlog.
He also had mentioned some recommendations as well, as far
as VBA bringing in an independent panel of IT experts to review
the plan and progress of the VBMS, such as Google, Apple,
Amazon. Is that something that the Department is willing to do?
General Hickey. So, thanks, Congressman. I don't have an
OIT person or an IT person here representing us on the panel,
but I will tell you there is lots of independent verification
that we are doing inside of EBA for a lot of our different
programs.
In fact, our claims ingest--our Veterans Claim Ingest
Program, which is our way now that we're getting into a
paperless environment, our scanning and the like, has now an
independent verification contract on it to help us make sure we
know that we are doing it right and well.
I will take that one for the question, respond to that one
for the question. I just don't have all the clean insights into
everything that happens on the IT side relative to that.
Mr. Michaud. Thank you. And my last question. I know we've
heard from the big six veterans service organizations and you
have sat down with them continuously as they raise concerns
about VBMS, because of their work with the National Service
Officers.
Have you reached out to the Iraq and Afghanistan Veterans
or other groups as well, even though they don't have service
officers?
General Hickey. I have two meetings that I do on a monthly
basis. One meeting is with our big six VSOs with the national
service officers. Another meeting is with our great
organizations like MOA and others like Navy League, all those
kinds of organizations.
I have invited, on that second panel, to meet with IAVA in
that group and I am more than willing to do so.
Mr. Michaud. Okay. Thank you. I yield back, Mr. Chairman.
The Chairman. Thank you very much, Mr. Michaud. Real
quickly, you have talked about being completely paperless by
2015, I know that is the goal. That is a great laudable goal,
as are most of the goals VA sets up. But given some testimony
that we received here in the Committee weeks ago regarding the
individual electronic health record, it appears that VA and DoD
are going on divergent paths again and DoD is fighting the
change that's coming. How is that going to impact your ability
to adjudicate the claims. They say they cooperate, but they
don't cooperate.
General Hickey. Chairman Miller, thanks for the question.
I'll tell that I am not IEHR, that is more on the health
administration side, though, when it is here it will obviously
benefit us, so I would prefer to take that piece for the
record. But I will tell you I am not waiting for anything like
that to--I am doing right now under a different agreement with
DoD, getting our hands on the complete medical record, the
contract medical records, the tricare medical records, all
brought together with a letter on top from DoD certifying they
have gone through the complete thing and everything is there
and they're presenting that to me now for point forward, all of
our Veterans are coming out now.
The Chairman. Okay. And also you highlighted e-benefits.
You have a great faith in that; here is a question that was
brought to me that you can take for the record. Apparently, you
can only download one page of documents to your e-benefits
file. Then it can take upwards of 75 days before it is
reflected as received in the system?
General Hickey. Chairman, I have to say that I don't
believe that that is accurate. I can tell you, I can download
and I have downloaded my complete personnel records and it
didn't take one page times all the rest of them. I got them in
a PDF version, I download them, I have them in my little, I
love me file at home and, no, it doesn't take all that time to
upload and upgrade that----
The Chairman. Well, it wasn't the time to upload, it is how
soon after you downloaded or uploaded all of that information
did it show up as received into the system?
General Hickey. I will go back and find out. I would love
to have the information that you have and go back and check on
it and I would be happy to provide you an answer to this.
The Chairman. Here it is, handwritten. Thank you very much
for being here for two hours. We appreciate you testifying and
providing the answers. I am sure that there are questions that
we will submit for the record. I appreciate both you and Ms.
Rubens being here. Once again, I want to say, thank you for
being here and being part of this discussion. This hearing is
adjourned.
[Whereupon, at 12:02 p.m. the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Jeff Miller, Chairman
The Committee will come to order.
Good morning everyone. Welcome to today's Full Committee hearing on
a topic that is not a new one for this Committee, namely, needed
improvements to the disability claims processing system.
As of this week, VA had nearly 900,000 pending claims, with over 70
percent pending for longer than VA's targeted processing time of 125
days. Recently, VA has rolled out its ``transformation plan'' as a
means to address the growing backlog of claims. Pursuant to Merriam
Webster's dictionary, ``transformation'' means the act of changing in
composition or structure.
Similarly, ``plan'' is defined as a detailed formulation of a
program or action. However, what we have seen from VA so far does not
amount to a significant change in the culture of the organization, nor
has VA provided a very detailed formulation of its plans for moving
forward.
Although it is my hope that VA is truly committing to changing the
culture of the department. Most of what we have seen so far consists of
repackaging old initiatives with new Power Point presentations and
impressive buzz words.
Speaking of buzz words, VA has repeatedly stated that it plans on
accomplishing its transformation plan by focusing on ``people, process,
and technology.'' Our purpose today is to focus on the first of these
three elements - people.
Although much emphasis is placed on the process and technology
components, I believe that the ``people'' component may be the most
important. There are thousands of men and women who, on a daily basis,
work through the growing backlog of claims and their efforts should not
go unacknowledged. Nonetheless, the more people VA hires to process
claims, the worse the department's productivity is.
Indeed, as the first chart shows, in 1997, the average VA field
employee processed 135 claims per year whereas in 2011, that number had
dropped to 73 claims per year. Further, as the second chart shows VA
has nearly three times as many field employees to do the work now than
it did fifteen years ago. One would think that working fewer cases per
employee would result in higher accuracy rates . . . but accuracy is
stagnant, and as the budget has grown exponentially. Unfortunately, so
too have processing delays.
As I have stated many times before, there are many people - myself
included - who are losing patience as we continue to hear the same
excuses from VA about increased workload and increased complexity of
claims.
Let me give everyone an example from VA's own budget books: I
quote, ``the effect of the military drawdown on VA's claims process is
marked not only by a large volume of claims being received, but also by
increasing complexity of those claims;'' ``as a result of the pre-
discharge counseling being given to service personnel . . . veterans
have been claiming more conditions on their initial applications;''
``instead of the traditional two to three disabilities per claim,
regional offices are dealing with 10 to 15 issues per claim.''
I could go on, but does this sound familiar to everyone? It should,
because what i just read to you was from VA's February 1994 budget
submission. VA has and will encounter complications along the way.
However, VA's demonstrated history shows its inability, or refusal, to
forecast problems and anticipate its needs and the only people paying a
price for this failure are the veterans. The time for excuses is over.
So, Under Secretary Hickey, we are here today to have an honest
discussion about the people who make up VBA - from file clerks to RO
directors to VA central office management, and on how you intend to
transform this workforce through better accountability and workload
management practices.
I recently had the opportunity to travel to the Baltimore Regional
Office. I was able to observe new employees' Challenge Training. I also
learned more about the station enhancement training that the Baltimore
Regional Office will soon undergo.
Although proper training is important, I'd like to reiterate that
it is not enough. VA also needs to remain focused on accountability and
better workload management practices. For example, one of the words we
hear most when VA is called before us is ``Nehmer.''
Nehmer, a class action lawsuit that requires VA to prioritize
certain Agent Orange presumptions - did significantly add to VA's
workload. However, during the 111th Congress, Secretary Shinseki
testified before this Committee that VA would easily be able to fast-
track those claims. I quote, ``by 2013, we will be back to where we are
today at about 161 days'' to process a claim.
Under Secretary Hickey, as you know, we are not there today. On the
contrary, we are at nearly 280 days for an initial rating decision.
Without better workload or surge capacity planning, I fear that VA is
simply one national mission away from complete collapse and utter
failure.
This is simply unacceptable, so again, we are here today to explore
how the people who make up VA can prevent this scenario from happening.
I'd like to thank Under Secretary Hickey for being here today, as well
as those who submitted statements for the record.
I now yield to our Ranking Member, Mr. Michaud.
Prepared Statement of Hon. Michael Michaud, Ranking Minority Member
Thank you very much, Mr. Chairman, for holding this hearing today.
I would like to take a brief moment to recognize that it has been a
decade since the start of Operation Iraqi Freedom. The wars in Iraq and
Afghanistan have claimed 6,669 American lives with 50,554 wounded in
action and countless others suffering from mental injuries as a result.
Thank you to our veteran advocates on this Committee and in the
audience who have worked hard to assist these fine men and women.
Since March of 2003, there is much that we should be proud of: a
post 9/11 GI Bill that ensures these veterans have the opportunity of
an excellent college education, record increases in the
administration's budget for VA programs and services that have led to
better care and access for our Nation's veterans, and many others.
However, despite these positive outcomes, we all know that
challenges remain.
Of great importance to not only current era veterans, but all
veterans, is our need to fix the broken claims processing system.
While the VA continues to process more claims than at any other
time in its history, demand continues to outpace production. Today,
VA's total inventory is approaching 900,000 claims with more than two-
thirds, or 632,000 of these claims considered as part of the backlog.
However, despite the growing backlog I am encouraged by some of the
recent developments and by the shift in attitude regarding VBA's
efforts to fix the backlog.
Nonetheless, while I appreciate the Secretary's goal of having no
veteran waiting for longer than 125 days with an accuracy rating of 98%
by 2015, I question whether this very, very, ambitious goal is
achievable. It would require the VA to complete approximately 3.4
million claims in two and a half years. To accomplish this goal, the VA
must start averaging the completion of 1.36 million claims a year; this
is a 33 percent increase in productivity. These are loose projections,
and I hope that the VA has better ones, but in my mind, the math simply
doesn't add up.
I also question whether VA is being upfront with Congress about its
challenges. In particular, does VBA have enough employees to get the
job done? I am not convinced that it does. And is VBA getting all of
the information that you need from the Department of Defense in a
timely fashion? I don't believe it is.
VA's ability to process claims in a paperless electronic
environment can only be as good as the information that goes into it.
If you don't have the resources required, and you are not receiving
information from DoD, or other agencies, we need to know about it.
Further, I am concerned that VBA is simply trying to automate a
claims process that, at the end of the day, doesn't work. I hope to
hear some of your ideas as to how your workload management will change
in an electronic setting.
Can VA visualize an electronic system in which a Veterans claim
comes in not as a claim, but broken down into the various medical
conditions?
For our purposes let's suppose there are 13 medical conditions in a
claim. These 13 medical conditions are not sent through the segmented
lanes of the veterans' local regional office; they are sent to 13
Regional Offices throughout the country, electronically,
simultaneously, to be adjudicated at the same time.
Different RO's specialize in different medical conditions.
Challenged RO's get the easy medical conditions; Great RO's get the
work that is the most complex. And most importantly, veterans get paid
as each medical condition is completed. I challenge VA to begin
thinking outside of the box.
It is an old adage that a benefit delayed is a benefit denied. Far
too many veterans are waiting far too many days to receive the benefits
they have earned. We are all working toward the same end - timely and
accurate dispositions of claims. If we are to be successful we must
work together to achieve a claims system that lives up to the service
and sacrifices of our veterans.
Thank you, Mr. Chairman. I yield back.
Prepared Statement of Hon. Tim Walz
I want to thank Chairman Miller and Ranking Member Michaud for
holding the hearing on Wednesday, March 20, 2013 titled: ``Focusing on
People: A Review of VA's Plans for Employee Training, Accountability,
and Workload Management to Improve Disability Claims Processing.''
Ending the disability claims backlog is of the utmost importance to
veterans and their families. The Chairman's and Ranking Member's focus
on the issue is commendable.
The Department of Veterans Affairs (VA) disability claims backlog
has been decades in the making, with many contributing factors. In
2009, with support from my-self and other Members of Congress,
Secretary Shinseki made the decision to establish presumptive service-
connection for three additional illnesses associated with exposure to
Agent Orange. Since this decision, VA has already reviewed more than
140,000 past claims for these diseases and is in the process of
reviewing more than 40,000 additional past claims.
But more than anything else, the backlog is the result of 12 years
of war. When the decision was made to invade Iraq in 2003, the country
was ill-prepared to care for all the returning war veterans that would
ensue. Approximately 45 percent of Iraq and Afghanistan veterans are
currently seeking compensation for injuries related to their service--
that marks a ``historical high'' compared to previous wars. Many of
these veterans are coming home with severe and complex injuries; which
is why today's claims include an average of 8 to 10 medical issues per
claim, more than double the Vietnam era.
Needless to say, we can't allow these challenges to prevent us from
delivering timely care and benefits to our returning servicemembers.
Our veterans deserve to come home to a government that provides the
same excellent service that we demanded of our servicemembers. Congress
must work with VA leadership to break this backlog. I believe that the
VA leadership possesses the will and the skill to break the backlog. My
friend Bob Wallace, Executive Director of the Veterans of Foreign Wars
of the U.S., recently stated it best:
``The Veterans of Foreign Wars of the United States strongly
believes in holding public servants accountable, but Allison Hickey was
handed a tremendous challenge less than two years ago when she became
the VA Undersecretary for Benefits, a challenge that continues to be
compounded by an aging veterans' population, additional presumptive
service connections for Vietnam and Gulf War veterans, and the influx
of new claims from Iraq and Afghanistan veterans. The VFW believes Ms.
Hickey is an integral part of the solution to finally breaking a
backlog that previous Administrations and Congresses helped to create
by underfunding the critical areas of automation and staffing. Thanks
to the President and Congress, the VA now has the necessary resources
to automate the claims processing system and move in the right
direction, but after years of neglect, the fix will not come
overnight.''
I understand that it is Congress's responsibility to provide
oversight over the Department of Veterans Affairs. But any criticism
directed towards VA leadership must be constructive. Pointing fingers
will not help. I recently suggested to Undersecretary Hickey that VA
stop taking a ``one-size fits all'' approach to training and begin to
tailor training to the needs of employees based on their experience and
location. I was pleased that Undersecretary Hickey acknowledged this
shortcoming and agreed to reevaluate their training programs.
I want VA's transformation to be successful though I have concerns,
particularly with: VA's ability to get records from the Department of
Defense in a timely fashion; how VA plans to operate in an electronic
environment; receiving qualifying data from VA regarding the
transformation; proper staffing ratios at VA Regional offices.
Nonetheless, I am optimistic that VA is moving in the right direction
in regards to their efforts to create a paperless processing system. I
am convinced that we can break the backlog. If we can put a man on the
moon, we can certainly ensure that veterans receive the benefits
they've earned in a timely fashion.
I look forward to continue working with the Veteran Service
Organizations, my colleagues on the House Veterans Affairs Committee
and VA leadership to develop a strategy to meet the growing needs of
our veterans.
Sincerely,
Tim Walz
Member of Congress
Prepared Statement of Hon. Jackie Walorski
Mr. Chairman and Ranking Member, it's an honor to serve on this
Committee.
I thank you for holding this hearing on an issue that significantly
affects our Nation's veterans.
This is an issue that greatly concerns me, and I stand firm in my
resolve to continue the work of this Committee until real progress is
made. I want the 50,000 \1\ veterans back in Indiana's Second
Congressional District, and the approximately 22,000,000 \2\ veterans
overall in this country to know that their voices have been heard.
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\1\ There are an estimated 53,318 veterans in IN-02. This data was
compiled on 09/30/2012, based on the district lines from the 112th
Congress. http://www.va.gov/vetdata/Veteran--Population.asp.
\1\ There are an estimated 22,700,000 veterans in the United
States. Department of Veterans Affairs, Office of the Actuary, Veteran
Population Projections Model (VetPop), 2007, Table 5L. http://
www.va.gov/vetdata/docs/quickfacts/Population-slideshow.pdf.
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The Veterans Administration cannot continue to make false promises.
The VA must act now. It is completely unacceptable that the backlog
grew from 180,000 claims to 594,000 claims in the period from 2009 to
December 2012. \3\
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\3\ Department of Veterans Affairs (VA) Strategic Plan to Eliminate
the Compensation Claims Backlog. 25 January 2013. https://
www.documentcloud.org/documents/612897-va-strategic-plan-jan-2013.html.
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The backlog and consequent wait times for the veterans is
demoralizing. I have heard from veterans who feel completely helpless
as a result of the way they must wait to receive the care they
desperately need. These men and women and their families have
sacrificed much to protect the liberties we are grateful for.
I look forward to working with my colleagues and our panelists,
today, to ensure our veterans do not become another statistic lost in
the system.
Thank you.
Prepared Statement of Allison A. Hickey
Good morning, Chairman Miller, Ranking Member Michaud, and Members
of the Committee. Thank you for the opportunity to discuss VA's plans
for employee training, accountability, and workload management to
improve disability claims processing. My testimony today will focus on
the employees of the Veterans Benefits Administration (VBA) and the
transformation initiatives we have underway to help them deliver on our
commitment to provide outstanding service and timely and accurate
benefits to our Nation's Veterans, their families, and survivors.
As a direct result of the budget support provided by the Committee,
VBA has completed more than one million disability compensation claims
the last three years in a row - the highest numbers ever in the history
of VA. Despite this stride, too many Veterans wait too long to get the
benefits they have earned and deserve. VBA continues to execute a
Transformation Plan that will enable us to meet the Secretary's goal of
claims completed in 125 days at a 98 percent accuracy level in pursuit
of eliminating the claims backlog in 2015.
Meeting the Needs of Veterans
Veterans, their family members, and Survivors deserve our very best
performance and the ability to deliver an array of benefits and
services that Veterans have earned - faster, more accurately, and with
greater efficiency and effectiveness.
It is the growing inventory of disability claims, and our need to
quickly process those claims, that is driving the urgency with which we
are advancing our Transformation.
VBA completed over one million claims per year in fiscal years
2010, 2011, and 2012. Yet the increased productivity in claims
processing was not enough to keep pace with the number of claims
received in several of those years. In 2010, VBA received 1.2 million
claims. In 2011, VBA received another 1.3 million claims, including
claims from Veterans made eligible for benefits as a result of the
Secretary's decision to add three new presumptive conditions for
Veterans exposed to Agent Orange. In 2012, VBA received 1.08 million
claims. Over the last three years, the claims backlog has grown from
180 thousand to 600 thousand claims at the beginning of this month.
For decades, the VBA system has carried an inventory of pending
claims, and a backlog that was undefined and therefore confused with
inventory. In 2010, the Secretary of Veterans Affairs defined the
backlog as any disability claim pending over 125 days and increased
transparency by making our performance against our established goals
available on the internet. The backlog grows when the capacity does not
match demand.
In 2009, based on the Institute of Medicine's Veterans and Agent
Orange: Update 2008, and considering all available scientific evidence,
the Secretary made the decision to add three presumptive conditions
(Parkinson's disease, ischemic heart disease, and B-cell leukemias) for
Veterans who served in the Republic of Vietnam or were otherwise
exposed to the herbicide Agent Orange. Beginning in 2010, VBA
identified claims for these three conditions for special handling to
ensure compliance with the provisions in the Nehmer court decision that
requires VA to re-adjudicate claims for these conditions that were
previously denied. Nehmer claims for all living Veterans were completed
as of April 2012. VA identified the next of kin for the last remaining
Nehmer survivor claim and awarded benefits in October 2012. As of March
11, VA has processed approximately 260 thousand claims and awarded over
$4.5 B in retroactive benefits for the three new Agent Orange
presumptive conditions to more than 164 thousand Veterans and
survivors.
Other factors that have resulted in the submission of more
disability claims, and hence contributed to the backlog, include VA
initiatives to increase access, and other conditions that increased
demand for VA to address unmet disability compensation needs:
Increased Access
1. Increased use of technology and social media by Veterans,
families, and survivors to self-inform about available benefits and
resources.
2. Improved access to benefits through the joint VA and DoD Pre-
Discharge programs.
3. Creation of additional presumptions of service connection
resulting in more claims for exposure-related disabilities.
4. Extensive and successful use of VA outreach programs to inform
more Veterans of their earned benefits, which can include compensation
claims.
Increased Demand
1. Ten years of war with increased survival rates for our wounded
2. Aging population of previous era Veterans such as Vietnam and
Korea, whose conditions are worsening
3. Impact of a difficult economy
4. Growth in the complexity of claims decisions as of result of the
increase in the average number of medical conditions for which each
claimant files.
The current composition of the inventory and backlog are claims
from Veterans of all eras--from Veterans of the current conflicts to
World War II Veterans who are just now filing a claim for the first
time. As of January 31, 2013, the largest cohorts of claims come from
our Vietnam-era Veterans who filed 448 thousand claims in FY 2012, and
currently make up 37 percent of the inventory and 38 percent of the
backlog. Gulf War Era Veterans make up 23 percent of the total
inventory and 22 percent of the backlog. Veterans of Iraq and
Afghanistan conflicts make up 20 percent of the total inventory and 22
percent of the backlog. Veterans of the Korean War and World War II and
all others make up less than 10 percent of both total inventory and
backlog. The remainder of the inventory and backlog is from Peacetime
Veterans only.
Transformation
To meet the Secretary's goal of eliminating the backlog by 2015, we
have set out to transform VBA into a 21st century organization. VBA's
transformation is demanded by a new era, emerging technologies, and the
latest demographic realities. In the face of increasing complexity and
workloads, VBA must deliver first-rate and timely benefits and services
- and they must be delivered with greater efficiency. VBA is
aggressively pursuing its Transformation Plan, a series of tightly
integrated people, process, and technology initiatives designed to
eliminate the claims backlog and achieve our goal of processing all
claims within 125 days with 98 percent accuracy in 2015. VBA is
retraining, reorganizing, streamlining business processes, and building
and implementing technology solutions based on the newly redesigned
processes in order to improve benefits delivery.
People
We very deliberately put our employees - our people - at the
forefront of our transformation plan, as they are the heart of our
mission and absolutely critical to achieving the Secretary's goal of
completing all claims in 125 days at 98 percent accuracy in 2015. Our
dedicated employees, 52 percent of whom are Veterans themselves, have
embraced our transformation efforts and are the key to our success. In
order to have the best-trained, most efficient, and highly skilled
workforce, we focused our ``people'' initiatives on strengthening the
expertise of our workforce - changing the way we are organized and our
employees are trained to do the work.
Our workforce is highly skilled and educated. Sixty-three percent
of our employees have a bachelors' degree or higher. The dedication of
our employees to our mission is evidenced by a very low turnover rate -
only 7 percent annually. The average length of service is 11 years; the
average age is 44; and 14 percent are currently retirement eligible.
However, over 35 percent of our claims processing employees have less
than three years experience with VA. We appreciate the budgetary
support provided by the Committee in recent years that allowed us to
increase staffing.
Training
VBA's focus is on providing high-quality, timely, and relevant
training for both new and experienced personnel. To that end, our
transformation efforts include redesigned and deployed centralized
programs and new tools that standardize training for the disability
compensation and pension benefit programs across our 56 regional
offices.
Challenge Training and Quality Review Teams (QRTs)
The productivity of the workforce and the accuracy of decisions are
being increased through new national training programs and standards.
VBA instituted Challenge training in 2011 and Quality Review Teams
(QRTs) in 2012 to improve employee training and accuracy while
decreasing rework time. Challenge training is focused on overall skills
and readiness of the workforce, and QRTs focus on improving performance
on the most common sources of error in the claims processing cycle;
data on VBA's largest sources of error are captured and analyzed by its
National Accuracy Team. Today, for example, QRTs are focused on the
process by which proper physical examinations are ordered; incorrect or
insufficient exams previously accounted for 30 percent of VBA's error
rate. As a result of this focus, VBA has seen a 23 percent improvement
in this area.
The 1,900 new employees who have received Challenge training decide
150 percent more claims per day than predecessor cohorts, with a 30
percent increase in accuracy, (i.e. these new employees decide 150
percent more claims per day than previous groups of employees at a
similar stage in their development). This is a marked improvement in
performance, and is being scaled across the entire enterprise as new
employees are hired. Five Challenge training sessions are planned for
FY 2013. As of March 1, 2012, VBA initiated a new Challenge course
focused on improving the low performing regional offices called Station
Enhancement Training (SET). The first regional office that completed
SET experienced a quality increase of eight percentage points in three
months and the number of claims processed per month increased by more
than 27 percent. Similar results are being seen by the second RO that
completed SET in January 2013.
VBA tracks the impact of these initiatives on accuracy through a
three-month rolling average accuracy metric that is reported in ASPIRE
and can be seen online by anyone inside or outside VA. FY 2012 data
demonstrated a three percent increase in national accuracy standards -
from 83 percent to 86 percent. The accuracy outcome objectives for the
next three years are: 90 percent in FY 2013, 93 percent in FY 2014, and
98 percent in FY 2015.
The current 12-month measure of the accuracy of our disability
rating decisions increased to over 86 percent - and further improved to
over 87 percent when looking at just the last three months. It is
important to recognize that under the existing quality review system,
any one error on the claim, no matter how many medical conditions must
be developed and evaluated, makes the entire claim in error - the claim
is therefore counted as either 100 percent accurate or 100 percent in
error, with no credit for anything in between. Issues are defined as
individually evaluated medical conditions. A claim can, and often does,
consist of many issues. Each issue represents a series of completed
tasks, such as development, research, adjudication, and decision, that
could result in a benefit adjustment for a Veteran, family member, or
survivor. Given that the average number of claimed issues for our
recently separated Servicemembers is now in the 12 to 16 range, we do
not believe the current all-or-nothing measure reflects the actual
level of decision accuracy achieved. When we measure the same claims
based on assessments of the individual medical conditions rated
(``issue-based accuracy''), the accuracy of our decisions is over 95
percent. This issue-based accuracy approach also affords VBA the
opportunity to target with precision those medical issues where we make
the most errors with dedicated training - and improve employee level
medical issue accuracy.
Training for Experienced Employees
All claims processors are currently required to complete at least
80 hours of VBA training annually. VBA's Compensation Service has
published a National Training Curriculum (NTC) for claims processors
and requires training at the appropriate skill level for all employees.
The 80 hours includes mandatory training from NTC, electives from NTC
on additional topics, and station-determined topics. Training is
conducted on issues of high interest or quality concerns for claims
processors, such as determining effective dates, determining
examination adequacy, and rating traumatic brain injury claims - skills
essential to accurately carrying out their everyday responsibilities.
The breakout among these three categories is flexible to allow
adjustments for urgent national and local issues with high impact on
claims processing.
VBA invests annually in the development, maintenance, and
management of formal training products and performance support tools.
VBA's formal training system, Training and Performance Support Systems
(TPSS), utilizes: web-based training for individual learning;
instructor-led web-based training for virtual classroom training; job
aids for standardized desktop references; and electronic performance
support systems (EPSS) to provide quick access to technical and medical
information that should not be memorized. All TPSS and EPSS products
are professionally developed and must pass rigorous validation testing.
TPSS and EPSS products are also utilized during Challenge training.
Station Enrichment Training
In March 2012, VBA initiated a new Challenge course specifically
designed to focus on improving decision accuracy and raising the skill
levels of employees working in low-performing regional offices. Station
Enrichment Training (SET) is intensive, instructor-based training built
on VBA's highly successful and redesigned Challenge training for all
new compensation claims processors. It provides standardized training
in the technical skills required of VSRs and RVSRs.
At the first office participating in the SET program, quality
increased by eight percentage points in three months, and the number of
claims processed per month increased by more than 27 percent. Since
SET, this office has met or exceeded its performance goals each month.
Based on the success of SET in the first office, VBA has since expanded
SET to two additional regional offices in this calendar year.
Change Management Training
Our Transformation, with its integrated people, process and
technology initiatives, represents the largest single reinvention this
organization has ever seen -and our focus is on managing this change
while sustaining production and improving quality. We recognize the
importance of helping our employees fully understand and prepare for
the major transformative changes being implemented. For each of the
transformation initiatives, VBA developed and fielded formal training
to prepare employees with consistent information - delivered at the
right time. Web-based training allows employees to learn at their own
pace and includes assessments for employees to confirm their learning.
Change Management Agents
VBA hired Change Management Agents (CMAs) at each regional office
and trained them as front-line proponents for transformation. CMAs
provide support to regional office employees to guide them through
changes and help them communicate their concerns. CMAs help regional
office management and VBA leadership by guiding implementation of each
initiative and channeling employee feedback. CMAs also ensure that
appropriate communication occurs with a variety of VA and external
stakeholders. VBA remains dedicated to helping employees prepare for
the changes and achieve success through improved processes and
technology.
Transformation Organizational Model
VBA's new standardized organizational model incorporates a case-
management approach to claims processing. VBA is reorganizing its
workforce into cross-functional teams that give employees visibility of
the entire processing cycle of a Veteran's claim. These cross-
functional teams work together on one of three segmented lanes:
express, special operations, or core. Distinct processing lanes are
based on the complexity and priority of the claims and employees are
assigned to the lanes based on their experience and skill levels.
Claims that predictably can take less time flow through an express lane
(30 percent); those taking more time or requiring special handling will
flow through a special operations lane (10 percent); and the rest of
the claims flow through the core lane (60 percent). Lanes were
established based on the complexity and priority of the claims and
employees are assigned to the lanes based on their experience and skill
levels.
The Express Lane was developed to identify those claims with a
limited number of medical conditions (1-2 issues) and subject matter
which could be developed and rated more quickly, including fully
developed claims. The Special Operations Lane applies intense focus and
case management on specific categories of claims that require special
processing or training (e.g., homeless, terminally ill, military sexual
trauma, former prisoners of war, seriously injured, etc.). The Core
Lane includes claims with three more medical issues that do not involve
special populations of Veterans. Less complex claims move quickly
through the system in the express lane, and the quality of our
decisions improves by assigning more experienced and skilled employees
to the more complex claims in our special operations lane.
Initially planned for deployment throughout FY 2013, VBA
accelerated the implementation of the new organizational model by nine
months due to early indications of its positive impact on performance.
Given the magnitude of this change, each office transitions to the new
organizational model individually. Significant support and training
from VBA Headquarters have been critical in this stage. As of the end
of 2012, the new organizational model was fully operational at 51
regional offices, and three more have since implemented the new model.
The remaining two regional offices will implement the model by the end
of this month.
Accountability
VBA holds employees at all levels of the organization accountable
for performance as we continuously strive to fulfill our commitment to
providing timely and accurate benefit decisions. Objective measures and
performance standards are used to make basic determinations that our
managers and employees are meeting or exceeding their job requirements.
Procedures are in place to reward our best performers and to work with
employees who need additional training to improve performance.
Accountability for Claims Processing Employees
Employees receive on-going feedback on the elements included in
their performance standards. Training continues to be a priority to
achieve our performance improvement goals and is provided in a variety
of methods, in addition to those already highlighted in this testimony.
For example, training is conducted through a national Quality Call
every month, where several staffs from Compensation Service address
error trends identified through national and regional office-specific
assessments.
If a supervisor determines that an employee is not meeting his or
her performance standards, the supervisor will identify specific,
performance-related problems. The supervisor and employee will develop
a written performance improvement plan to identify specific performance
deficiencies, successful level of performance, actions that must be
taken to be successful, and the methods that will be used to measure
improvement. The performance improvement plan provides the employee a
reasonable opportunity to resolve performance-related problems.
Generally, the plan covers at least 90 calendar days, but it may be
extended.
We recognize the importance of assessing the impact of our
transformational initiatives on employees' job requirements and
appropriately adjusting performance standards. Performance standards
and objective measures are used to make a basic determination that an
employee is meeting their job requirements. We recently revised our
performance standards, and are still within the 90 day period of
implementation. The new performance standards account for segmented
lanes and ensure that work credit is assigned appropriately. VBA
established a new team to work in conjunction with AFGE to continue to
develop standards that will better serve Veterans as we move into an
electronic environment.
This past year, the VBA Mid-Term Bargaining Committee, comprised of
members representing the American Federation of Government Employees
(AFGE) and VBA management, worked in partnership and through pre-
decisional involvement to support the design and deployment of all our
transformation initiatives. VBA leadership ensures that all pilots of
potential transformation initiatives include our labor and VSO partners
to build the process with the employee in mind. In addition, pre-
decisional briefings on transformation were provided to help pave the
way for negotiations. The team resolved many issues and reached
agreement on approximately twenty memorandums of understanding.
Skills Certification
VBA incorporated its skills certification program in the
Transformation Plan, as it is an important tool to ensure
accountability for claims processors. Public Law 110-389, Section 225,
required skills certification testing for employees and supervisors who
process claims for compensation and pension benefits. Since August
2003, VBA has maintained a skills certification testing program. Tests
are currently administered on a regular basis for the following
positions: VSR, RVSR, Supervisory VSR, Pension Management Center VSR,
Decision Review Officer and Coaches. Employees and supervisors are
required to achieve certification and recertify every two years.
Public Law 112-154, Section 703, added the requirement that VBA
regularly assess the skills and competencies of appropriate employees
and managers responsible for processing claims for compensation and
pension benefits, as well as take appropriate personnel action if
employees and supervisors are unable to pass the test following
training and reassessment. We have developed a plan to regularly assess
the skills and competencies of employees who process claims for
compensation and pension benefits. Implementation of this plan will
occur after notification and appropriate action is taken with labor
partners to address its impact and implementation.
As a result of extensive labor-partner input obtained in a labor
and management forum, VBA is considering various options to implement
the provision of the law requiring VBA to take ``appropriate personnel
action'' if training and reassessment does not result in satisfactory
skills and competencies. VBA is reviewing the input of our labor
partners to formulate options for those employees who do not pass the
skills certification test after additional training and reassessment.
Regardless of which option is selected, VBA will bargain on issues
related to impact and implementation, as is required by the AFGE Master
Agreement.
Workload Management and Accountability for Senior Managers
ALL VBA senior managers of regional offices are held accountable
for effective workload management and the resulting performance of
their offices. Performance is evaluated against national and regional-
office-specific targets that are based on our strategic goals. The
targets are established at the beginning of each fiscal year and
account for a variety of measures, including timeliness, production,
and inventory. Performance expectations are established based on the
previous year's performance, giving consideration to current staffing
and anticipated receipts at each regional office. VBA's Office of Field
Operations and the Area Directors routinely review the performance of
regional offices and their leadership teams. The performance is
measured against established targets, workload, and staff turnover.
VBA aggressively monitors regional office workload trends and
performance, and as negative trends develop, Area Directors establish
and monitor performance improvement plans for regional office directors
to ensure appropriate attention is given to problem areas. The
performance improvement plans identify any deficiencies such as
productive capacity, quality, or timeliness. Often, a challenged
regional office will engage a high performing station to share best
practices and identify opportunities for improvement.
VBA's office of Field Operations and the Area Directors actively
participate in rehabilitating an underperforming regional office. VBA
established a Workload Management Training Program to train new
supervisors in workload management. VBA will also host classes at the
facility to re-engage claims processors and management staff. The new
SET program previously discussed is an important new tool for
performance improvement. The Area Directors will engage in more
frequent communication with an underperforming office, through frequent
site visits, teleconferences, and written and electronic
communications. If a Director cannot successfully lead a regional
office to improvement, subsequent performance action will be taken
during performance appraisal periods. These actions may include
retirement, reassignment, or downgrade.
Stat Reviews
VBA's Stat Reviews are a performance technique and tool using
statistical data (Stat) and visual displays of that data to monitor
progress and improve performance. This process involves in-depth
performance metric reviews with the Under Secretary of Benefits (USB)
and other top VA leaders, as well as VBA's Office of Field Operations
and other members of the VBA leadership team, to analyze and manage
performance more effectively.
VBA's Stat Reviews are based on highly successful performance
management programs conducted government-wide. As USB, I sit at the
table with regional office directors in the day-long meeting to discuss
challenges and successes, using extensive data driven performance
measures for accountability. This allows VBA leadership to more easily
identify what improvements are needed to produce desired performance
results. Stat Reviews also help VBA leadership understand what is or is
not working, while motivating regional office managers and employees to
focus their energy and creativity on achieving specific results.
The Stat Review process encourages:
1. Focus on accountability to achieve workload performance metrics.
2. Information-sharing of best practices across VBA regional
offices and VBA leadership.
As a monthly event with Directors and a bi-weekly update with the
USB, the Stat Reviews identify patterns occurring at various regional
offices, and every regional office participates either in person or by
teleconference. These reviews help to ensure we have alignment across
ROs on Transformation and that best practices and lessons learned are
shared quickly across leadership teams.
Career Trajectory
VBA believes very strongly in providing employees with growth
opportunities and therefore provides a career trajectory for claims
processing employees working across the nation. Over the past two
fiscal years, VBA promoted 1,061 claims processing employees,
including:
258 claims assistants promoted to Veterans Service
Representatives (VSRs),
542 VSRs promoted to Rating VSRs (RVSRs); and
261 RVSRs promoted to Decision Review Officers (DROs).
The knowledge and experience our employees bring to their jobs as
they are promoted to more technical and leadership positions are
invaluable to our organization. Developing our employees for positions
of greater responsibility helps to ensure employees understand the
various roles in the claims process and our institutional knowledge is
preserved and enhanced.
Helping employees understand the skill requirements of their
current and potential future positions is a key component of VBA's
succession planning. VBA has built competency models that describe in
detail the general and technical skills and competencies required for
15 critical and nationally standardized positions across its six lines
of business. VBA is now focusing on developing a repeatable process of
curriculum mapping, using the VSR position as a proof of concept. When
complete and loaded into VA's Talent Management System, employees and
their supervisors will use the competency models to evaluate and
address learning needs and performance improvement opportunities for
employees. The competency models will help to specify the learning,
experience, and other qualities necessary to perform job tasks.
Employees and those who desire to work with VBA will also benefit from
these models, as they provide the foundation for VA's on-line career
mapping tool MyCareer@VA, which itself has a broad audience of some
575,000 users (to date, since October 2011).
VBA has planned for employee growth in both leadership
opportunities and technical expertise to ensure the long-term health of
the organization. For all business lines, VBA's Office of Employee
Development and Training develops and manages leadership and
professional development programs. Our five national leadership
development programs reach a wide population of leaders and potential
leaders throughout our organization with programs for emerging leaders
(GS 5-9) through our executive development series (SES). These
competitive programs are available to employees from all regional
offices and centers. Each program provides instructional and
experiential learning opportunities as well as mentoring to enhance
each participant's growth.
Incentives
VBA utilizes a three-tier incentive program to recognize
individuals and regional offices for excellent performance during the
fiscal year. Individual recognition (level I), awards are given to
those employees whose performance significantly exceeds their
performance requirements. All performance requirements for claims
examiners contain critical elements for both quality and timeliness/
production. At the heart of the performance award program is a
foundational focus on quality. Funding for level one of the program is
distributed to regional offices based on a percentage of total salary
for each office. Level one funds are paid out to individual employees
locally as incentive awards, and the criteria for performance are
determined locally and vary across regional offices.
Group awards (level two) are made to offices or elements of offices
that achieve and exceed performance targets. Funding for level two of
the program is distributed to regional offices for meeting key
performance targets during the fiscal year, including all claims
accuracy goals. Funding for level two awards is pro-rated based on
total salary for employees in each business line for which the regional
office met the level two criteria.
Special contribution awards (level three) of the program are
reserved for recognition by the Under Secretary for Benefits.
Recommendations at this level are made by the Deputy Under Secretary
for Field Operations.
Employee Morale
Today VBA and our employees face enormous challenges - and we need
the talents of each and every one of our employees to overcome those
challenges and succeed in our Transformation. Our employees demonstrate
every day that they are motivated to make a difference in the
organizations where they work and in the lives of those they serve.
Their strongest motivation is their dedication to our unique mission of
service to America's Veterans, their families and Survivors.
We recognize our responsibility for developing, sustaining, and
nurturing our employees - highlighting their accomplishments,
addressing their concerns, and giving them the training and tools they
need to deliver quality benefits and services to the Veterans and
families who are turning to them for assistance.
Our directors use a number of innovative methods to facilitate
communications, identify and address issues of concern, and help
employees understand the importance of the work that they do. Many have
invited OIF/OEF Veterans to the office to meet and speak with employees
so they gain a better understanding of the daily challenges our
disabled combat Veterans face. Town Hall meetings are held with
employees to improve communications between the management team
employees, and some managers also hold morning team sessions to ensure
that employees are kept up-to-date. CMAs also facilitate communications
between employees and managers related to our Transformation
initiatives.
VBA encourages all employees to participate in the annual All
Employee Survey, the results of which are carefully assessed and
analyzed to focus on areas needing improvement to promote a healthy and
motivated workforce. Regional office directors are required to select
two measures where they have influence to demonstrate improvement in
metrics. These metrics are evaluated by their Area Director at the end
of the performance period.
Process Initiatives
Through process-improvement initiatives, VBA is rapidly developing
and testing streamlined business processes, focusing on eliminating
repetition and rework. VBA established a ``Design Team'' concept to
support business-process transformation, and the ideas and input of our
employees are the key elements of this concept. Using design teams, VBA
conducts rapid development and testing of process changes and automated
processing tools in the workplace. The direct involvement of our
employees in the design team process enables us to demonstrate through
pilot initiatives that changes are actionable and effective before they
are implemented nationwide.
Since 2009, VBA has actively solicited innovative ideas for process
improvement not only from our employees, but also from Veterans and
industry stakeholders through a variety of structured mechanisms.
Literally thousands of ideas were received and culled down to those
with the largest potential to attack the backlog. For example,
automated Disability Benefits Questionnaires (DBQs) (discussed below) -
arguably one of the most highly leveraged changes - came from one of
the VBA employee idea competitions. Additionally, VBA also conducted
Lean Six Sigma and Kaizen events on these selected targets of
opportunity, all focused on five major areas of focus: wait time,
rework, productivity, digital intake, and variance.
Simplified Notification Letters
The Simplified Notification Letter, another employee-recommended
initiative, has reduced keystrokes and automated production language in
preparation of the Veteran's decision letter, thus improving rating
decision productivity and accuracy. VBA implemented this initiative
nationally on March 1, 2012, and it decreased the number of claims
``waiting'' for a rating decision by 55 percent. This translated into
over 10,000 more rating decisions in the month of December (94,292)
than in the month of March (84,115). The SNL process does not change
the way we consider and decide claims, but rather changes the primary
focus of what appears in the final decision document. We do this in
part through the use of an internal coding system designed to
streamline processing and communicate standardized reasons and bases
from the decision makers to the award processors (who generate the
final notice letters, authorize the monetary awards, and perform other
ministerial functions). SNL increased the number of auto-text
selections available for raters to use to explain decisions, thereby
improving decision accuracy and productivity. SNL allows VBA to meet
the requirements of the Plain Writing Act focused on simplifying
communications with benefit recipients.
Calculators and Evaluation Builder
VBA is building new decision-support tools to make our employees
more efficient and their decisions more consistent and accurate. We
have already developed rules-based calculators for disability claims
decision-makers to provide suggested evaluations. For example, the
hearing loss calculator automates decisions using objective audiology
data and rules-based functionality to provide the decision-maker with a
suggested decision.
The Evaluation Builder is essentially an interactive disability
rating schedule. The VBA decision-maker uses a series of check boxes
that are associated with the Veteran's symptoms. The Evaluation Builder
determines the proper diagnostic code out of over 800 codes as well as
the level of compensation based on the Veteran's symptoms. The Veteran
receives an accurate rating decision every time the Evaluation Builder
is used. This saves employees time that would have been spent looking
up the rating schedule in a paper format. To date, five of the 15 body
systems in the VA Schedule of Rating Disabilities have been embedded
into VBMS, and the Evaluation Builder will have complete functionality
(all body systems) in VBMS by November of this year.
Disability Benefits Questionnaires (DBQs)
DBQs replace traditional VA examination reports and are designed to
capture all the needed medical information relevant to a specific
condition at once and up front so that claims can be developed and
processed in a more timely and accurate manner, with the end result
being faster service for Veterans. DBQs change the way medical evidence
is collected, giving Veterans the option of having their private
physician complete a DBQ that provides the medical information needed
to rate their claims - minimizing the need for a VA exam which adds
additional time to the claim development process. Information in the
DBQs maps to the VA Schedule for Rating Disabilities, and provides all
of the necessary information to decide a disability claim. Fully and
properly completed DBQs, whether from private providers or within the
internal VA examination processes, have the potential to reduce rework,
the largest category being exams with insufficient information.
The Veterans Health Administration has completed more than 1.5
million DBQs to date. In FY 2013 to date, nearly 600,000 DBQs have been
completed by VHA examiners. Since their introduction, VBA has received
over 12,000 DBQs outside of the traditional examination process. Using
DBQs, VA examination and examination-request accuracy improved to 92
percent nationwide, compared to the legacy quality program, which
showed accuracy of 84 percent when last conducted in 2009. Seventy-one
of eighty-one individual DBQs, unique forms designed to document
specific health conditions are available to private physicians. VBA is
reaching out to stakeholders, particularly Veterans Service
Organizations (VSOs), State and County partners, and private medical
doctors to request their support in encouraging Veterans to use DBQs
for more timely and accurate rating decisions. VA recently secured DoD
concurrence to pilot the use of DBQs within the Integrated Disability
Evaluation System (IDES) process. VBA's future goal is to turn DBQ
objective responses into data to drive a calculator-based business-
rules engine in VBMS to achieve automated decision support to improve
consistency and accuracy of decisions and reduce processing time per
case.
Acceptable Clinical Evidence (ACE)
ACE is a new approach that was implemented in October 2012. This
process allows clinicians to review existing medical evidence and
determine whether that evidence can be used to complete a DBQ without
requiring the Veteran to report for an in-person examination. For many
Veterans, this means they no longer need to travel and take time off
for an examination, which can be a significant burden requiring them to
leave work and interfering with their family life. Clinicians also have
the option to supplement medical evidence with telephone interviews
with the Veteran, or to conduct an in-person examination if determined
necessary. To date, VA has processed 1,931 claims using the ACE
initiative.
Compensation and Pension Records Interchange (CAPRI)
CAPRI software provides VBA employees with a standardized, user-
friendly method to access Veterans' medical records throughout the VA
healthcare system. In November 2011, VBA stopped printing Veterans
Health Administration (VHA) treatment records, saving the effort and
dollars associated with printing, filing, and storing these records.
Under a partnership with VHA, the CAPRI program has recently been
enhanced to send records electronically to VBA's paperless repository
with just a few mouse clicks, further simplifying the process and
reducing the task time. As of March 1, 2013, 45 sites within VBA have
received this upgrade, with deployment for remaining sites scheduled to
begin on March 31, 2013. To date, VBA has avoided printing more than 90
million pages of digital medical records (currently averaging six
million/month) and spending over 422,000 man hours printing and filing
- saving time and resources that are redirected towards backlog
elimination. Because of these CAPRI enhancements, VBA estimates a $2.5
million cost avoidance annually on paper and toner that is also being
used to support staffing resources to help eliminate the backlog.
Fully Developed Claims (FDCs)
FDCs are critical to achieving VBA's goals and provide a method for
our VSO and DoD partners to assist in gathering the necessary evidence
to decide a claim. A fully developed claim is one that includes all DoD
service medical and personnel records, including entrance and exit
exams, applicable DBQs, any private medical records, and a fully
completed claim form. An FDC is critical to reducing ``wait time'' and
``rework''. VBA currently receives 4.8 percent of claims in fully
developed form, which equates to 5,600 claims this fiscal year through
February. When a qualified FDC is received, VBA is able to discharge
its evidence-gathering responsibilities under the Veterans Claims
Assistance Act much more efficiently than in traditional claims. This
evidence-gathering period is a major portion of the current 262-day
process. Today, VBA completes these FDCs in 117 days. VBA's target for
FY 2013 is to increase these FDCs to 20 percent with our VSO partners-
meaning VBA will have the ability, if this goal is reached, to decide
153,000 additional claims in 117 days.
Internal Revenue Service and Social Security Administration Data
Sharing
In February 2013, VA developed an expanded data-sharing initiative
with the Internal Revenue Service (IRS) and Social Security
Administration (SSA) for up-front verification of income for pension
applicants and to streamline income verification matches. This
initiative enabled VBA to eliminate an annual reporting surge of
150,000 work items and redirect significant FTE to address the backlog
of Dependency and Indemnity Compensation (DIC) claims from Survivors.
We have doubled our output of DIC claims with this effort.
Technology
Key to VBA's transformation is ending the reliance on the outmoded
paper-intensive processes. VBA is deploying technology solutions that
improve access, drive automation, reduce variance, and enable faster
and more efficient operations. VBA's digital, paperless environment
also enables greater exchange of information and increased transparency
to Veterans, the workforce, and stakeholders. Our technology
initiatives are designed to transform claims processing from the time
the Servicemember first enrolls in the joint VA and DoD eBenefits
system and submits an on-line application to the issuance of the claims
decision and receipt of compensation payments.
Veterans Benefits Management System (VBMS)
VBMS is a web-based, electronic claims processing solution
complemented by improved business processes. It will assist in
eliminating the existing claims backlog and serve as the technology
platform for quicker, more accurate claims processing.
National deployment of VBMS began in 2012, with 18 regional offices
operational as of the end of the calendar year. Deployment to the 38
remaining stations is ongoing. We estimate that once VBMS is fully
developed in 2015, integrated, and implemented, it will help improve
VBA's production by at least 20 percent (in each of fiscal years 2014
and 2015) and accuracy by at least eight percent.
The evolution of VBMS is occurring across four distinct phases, or
generations of development. Generation One of VBMS began in 2010 with
the conceptualization, piloting, development, and deployment of
baseline system functionality with improved quality (required actions
and automation) and efficiency (no paper). Generation One of VBMS
concluded with the successful implementation of Release 4.1 in January
2013. This generation culminated in a foundational web-based,
electronic claims processing solution featuring:
Integrated claims establishment, development, and rating
capabilities;
Basic baseline automation via features such as automated
letter generation and data population; and
Basic workflow and workload management capabilities.
With the deployment of the latest system release, integration with
VONAPP Direct Connect (VDC) and the Stakeholder Enterprise Portal (SEP)
further enhanced the system's capabilities by improving data exchange
and status transparency with applicants, VSO partners, State and County
Veterans agencies, and other stakeholders.
At the end of February, 2013, 1,084 paper-based and electronic
claims have been rated using VBMS and 77,393 electronic folders
(eFolders) have been created in VBMS. Claims are being completed in
VBMS in an average of 92.4 days. There are over 12,000 users of VBMS to
include VHA and VSOs. VBMS has also successfully received over 2.5
million documents and over 32.2 million images.
As we move into Generation Two of VBMS, the focus is on building
additional system capabilities while leveraging simple automation
features and deploying the system to all remaining sites. Upcoming
system releases include planned improvements to correspondence and work
queue tools, additional rating calculator functionality, and more
extensive data exchange and system integration capabilities.
National deployment of VBMS to all 56 regional offices is on track
for completion in 2013. Each VBMS site deployment is supported by
organizational change management practices (including training) to
ensure business lines are able to adapt to and adopt the new
technologies and solutions.
Generation Three of VBMS in 2014 will focus on continuing to
improve electronic claims processing by providing increased system
functionality and more complex automation capabilities for all VBMS
end-users. VBMS enhancements will reduce dependency on legacy systems
for claims establishment, development, and rating. VBMS will have the
capability to accept electronic Veterans' Service Treatment Records
(STRs) and Personnel Records from DoD in support of the VOW to Hire
Heroes legislation. Additionally, VBMS end-users (to include VA Medical
Center personnel and VSOs) will be able to leverage enhanced system
functionality to perform their work more efficiently and accurately.
Development of functionality will provide end-users with the ability to
process claims electronically from receipt to payment. The addition of
functionality throughout 2014 and stabilization of system capabilities,
in conjunction with business process improvements, will increase
production and quality of claim decisions. This period of stability
will also allow VA an additional opportunity to assess and validate the
effectiveness of the model as a whole and implement improvements as
needed.
Generation Four of VBMS in 2015 will capitalize on efficiencies and
quality improvements gained during the year of stabilization. These
enhancements will allow employees to focus on more difficult claims by
reducing the time required to process less complex claims. This period
will also allow VA to identify additional automation and process
improvement opportunities, enabling VA to meet the Secretary's goal of
processing all claims within 125 days at 98 percent accuracy.
When a claim is granted in VBMS, a payment is processed, and
notification is sent to the Veteran through eBenefits and stakeholders
through Stakeholder Enterprise Portal (SEP). This notification
completes the full lifecycle of paperless claims processing, from
portal to payment.
Veterans Relationship Management (VRM)
VRM engages, empowers, and serves Veterans and other claimants with
seamless, secure, and on-demand access to benefits and service
information. Veterans now have access to benefits information from
multiple channels - on the phone, on line, or through our shared DoD/VA
portal called eBenefits. VRM provides multiple self-service options for
Veterans and other stakeholders.
eBenefits
eBenefits - a joint VA-DoD client-services portal for life-long
engagement with Servicemembers, Veterans, and their families - is a key
component of VRM. eBenefits currently provides users with over 45 self-
service options and greater access to benefits and health information
at the time and method of their choosing. Through the eBenefits portal,
users can now check the status of claims or appeals, review VA payment
history, obtain military documents, and perform numerous other benefit
actions. Veterans can also view their scheduled VA medical
appointments, file benefits claims online in a Turbo Claim-like
approach, and upload supporting claims information that feeds our
paperless claims process.
There are currently over 2.5 million eBenefits users, a more than
800 percent increase since June 2011. Through self-service, eBenefits
users have generated over 228,000 requests for official military
personnel documents, 198,000 requests for VA Guaranteed home loan
certificates of eligibility, 16.5 million claim status requests, and
over 1.7 million self-service letters. Additional functionality and
features will continue to be added to the site in the future, and VA
will use milestones and life events to proactively notify Veterans
about benefits they may be eligible to receive.
VDC (Veterans Online Application, Direct Connect)
VDC incorporates a complete redesign of the legacy VONAPP
application system, leveraging the eBenefits portal. Claims filed
through eBenefits use VDC to load information and data directly into
the new VBMS application for paperless processing. Veterans can now
file both original and supplemental compensation claims through VDC.
Since the expanded version of VDC deployed in October 2012, over 1,500
claims have been received.
Stakeholder Enterprise Portal (SEP)
SEP is a secure web-based access point for VA's business partners.
This portal provides the ability for VSOs and other external VA
business partners to represent Veterans quickly, efficiently, and
electronically. Because SEP is a new release, specific results are not
yet available.
VCIP
VBA recently established the Veterans Claims Intake Program (VCIP).
This program is tasked with streamlining processes for receiving
records and data into VBMS and other VBA systems. Scanning operations
and the transfer of Veteran data into VBMS are primary intake
capabilities that are managed by VCIP. As VBMS is deployed to
additional regional offices, document scanning becomes increasingly
important as the main mechanism for transitioning from paper-based
claim folders to the new electronic environment. The VCIP contractors
began scanning on September 10, 2012. The ramp-up volume mirrored the
VBMS deployment plan for the 18 regional offices on VBMS as of the end
of CY 2012. By the end of December 2012, the VBA contractors were
providing five million images per month. By the end of CY 2013, the
contractors will be providing up to 70 million images per month as they
convert paper records to electronic format.
Strategic Planning and Governance
VBA's Office of Strategic Planning (OSP) coordinates VBA's
strategic planning and the governance process for developing new
transformation initiatives. The focus of this office is on creating a
culture centered on advocacy for Veterans, reengineering business
processes, integrating new technologies, and redesigning our
organization and infrastructure. New ideas are approved through a
governance process that includes senior VBA leadership who serve on the
VBA Transformation Governance Board responsible for evaluating and
making recommendations for my approval. This ensures VBA's focus is on
implementing initiatives that will achieve the greatest gains, without
degrading current performance.
The VBA Implementation Center/Operations Center (VBA-IC/OC) is a
division of the Office of Field Operations. The VBA-IC/OC prepares,
executes and assesses the implementation of transformation initiatives,
managing the project lifecycle through a comprehensive Work Breakdown
Structure (WBS) and Critical Path methodology. The VBA-IC/OC also
serves as the liaison between the field and Headquarters throughout the
implementation process, providing channels of communication that are
essential to successful implementation. The VBA-IC/OC monitors and
supports regional offices through an end-user hotline, which is open
during normal business hours. In addition, I hold weekly three-hour
``pulse-check'' calls with the employees of all regional offices
adopting new initiatives to ensure all issues are raised and properly
assessed. The VBA-IC/OC gathers and reports implementation performance
metrics to provide support for VA leadership decision-making.
Partnerships
Support from our partners and stakeholders is critical to better
serving our Veterans, Servicemembers, and their families. Our
transformation changes our interactions with employees, other Federal
agencies, VSOs, and State and County service officers. VBA has worked
to create partnerships through pilot projects with these organizations
to improve benefits delivery. I continue to meet monthly with the
Executive Directors of six national VSOs and have established quarterly
stakeholder meetings with a larger group of VSOs directly affected by
new processes and initiatives. VBA engages these organizations for
their feedback and input at the beginning stages of the various
initiatives.
While stakeholder engagement is important to nearly all of VBA's
transformation initiatives, support from VSOs and State and County
service officers will be especially critical to the success of four
initiatives: eBenefits, SEP, FDC, and DBQs. VBA has involved
stakeholders in development, user-access testing, and training for
these initiatives, and we are now partnering to increase Veterans'
awareness and utilization in order to expedite the claims process.
VBA is exploring incentives for its VSO and State and County
partners to increase FDC submission because of the game-changing impact
this can have on claims-decision timeliness and eliminating the
disability claims backlog. A 20-percent FDC submission level is
estimated to increase annual production by 70,000 claims and reduce
overall average days to complete by 18 days.
VBA has an agreement with DoD to provide 100-percent-complete
service treatment and personnel records in an electronic, searchable
format for the 300,000 annually departing Active Duty, National Guard
and Reserve Servicemembers. This will further increase the number of
FDCs. When implemented, this action has potential to cut as much as 60-
90 days from the ``awaiting evidence'' portion of claims processing,
and reduce the time needed to make a claim ``ready for decision'' from
133 days currently to 73 days for departing Servicemembers.
VBA will continue to pursue various partnerships with Federal
agencies, VSOs, as well as profit and non-profit organizations to
expand and enhance our transformation initiatives.
Conclusion
VA is in an era of unprecedented production and unprecedented
demand, and our Transformation Plan is critical to achieving our goals
for improving the delivery of benefits to our Veterans, their families,
and Survivors. We will continue to vigorously pursue our people,
process and technology-centered improvements designed to eliminate the
claims backlog and achieve our goal in 2015 of processing all claims
within 125 days with 98 percent accuracy.
Mr. Chairman, this concludes my statement. I would be pleased to
answer any questions you or other Members of the Committee may have.
Statements For The Record
AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES, AFL-CIO AND THE AFGE
NATIONAL VETERANS' AFFAIRS COUNCIL
Overview
The American Federation of Government Employees and the AFGE
National Veterans' Affairs Council (hereinafter ``AFGE''), the
exclusive representative of employees processing disability claims at
Veterans Benefits Administration (VBA) Regional Offices (ROs) supports
the Department's Transformation efforts and appreciates the opportunity
to share our concerns and recommendations regarding employee training,
accountability and workload management in order to improve the
timeliness and accuracy of disability claims processing.
Summary of Recommendations
Training: AFGE urges flexibility to address training needs of
individual ROs, while maintaining national consistency and quality.
Also, new employees need sufficient training before being rushed into
production. Management should be held accountable for providing
sufficient time for training, including adequate classroom training
with actual cases incorporated into the curriculum. Front line
employees and their AFGE representatives should have input into ongoing
efforts to develop and improve training programs.
Effective Performance Measures and Workplace Morale: VBA needs to
create a valid, evidence-based time motion study for all aspects of
claims process in order to implement fair and accurate performance
standards. Management should constantly monitor morale and address
morale issues as a critical component of workplace management.
Career Opportunities and Management Incentives: VBA should develop
better VSR incentives to encourage experienced VSRs to stay in their
current positions through using different tiers, e.g. Super VSRs.
Managers should credit time already spent in a current position if an
employee seeks to move from a VSR to an RVSR or DRO position. Pathways
for promotion should be clearly communicated to employees. Management
incentives that reward quality should be strengthened. All RO employees
should be rewarded performance incentives, rather than only managers.
Greater input from front line employees and their AFGE
representatives: AFGE and its local officers should be regular
participants in weekly calls with General Hickey, and have a meaningful
opportunity to contribute and share their views.
AFGE surveyed its members processing disability claims to address
workforce issues. We received responses from the following ROs that are
discussed below:
Winston Salem, NC
Detroit, MI
Huntington, WV
Columbia, SC
St. Paul, MN
Newark, NJ
Waco, TX
Milwaukee, WI
St. Petersburg, FL
Pittsburgh, PA
Jacksonville, FL
Louisville, KY
Chicago, IL
Anchorage, AK
Togus, ME
Cleveland, OH
Los Angeles, CA
Portland, OR
VBA employees responding to the Subcommittee's request consistently
expressed their dedication and sense of purpose in serving the
veterans. Over half (52%) of VBA employees are veterans themselves, and
many of these employees receive benefits from the VA. Therefore, many
have direct personal experiences with the claims backlog. Despite their
frustrations, VBA employees uniformly remain steadfast in their goal to
serve veterans, work hand in hand with Veteran Service Organizations,
and do all that they can to work with VA to lower the unacceptably high
backlog of cases. As was described by an employee at the Huntington, WV
RO, ``I, like most of my coworkers, love the job itself. We love
serving veterans and their families; and take great pride in doing so .
. . However, I believe there are better, more productive ways to get
results.''
VBA has rolled out new standardized training to try to improve
timeliness and accuracy of the work product. However, ROs consistently
reported that the new training technique and methodology did little to
improve timeliness and accuracy. Several of the problems are listed
below.
One Size Fits All Training
A consistent theme throughout the ROs is that VBA management takes
a ``one size fits all'' approach when creating their training
materials. The training is not broken up between specific offices, and
longtime employees receive the same training as newer employees. There
is also no consideration of areas of performance when determining which
type of training to give which employees. The Jacksonville, FL RO
stated: ``Employee training is too rigid as far as the mandatory
national training core subjects and hours required. There needs to be
more flexibility in order to tailor training to the needs of the RO. We
wind up training on the same subjects year in, year out without being
able to have training to accommodate our needs at the local level.''
For example, in Anchorage, AK, we heard an issue regarding training
and the new lanes VBMS uses. With VBMS, Veterans Service
Representatives (VSRs) and Rating VSRs (RVSRs) are placed into
different lanes in order to allow for quicker cases to move through the
claims process faster and to give more time and care to the longer
cases. However, training does not differentiate between the different
lanes, meaning all VSRs attend training together regardless of which
lane they have been assigned. This applies for RVSRs as well.
ROs also consistently mentioned that the training was not dynamic
and did little to capture listeners' attentions. Training tends to
consist of reading information off a PowerPoint. They also would prefer
more group and practical exercises to increase productivity. Many
employees also complained about the lack of question and answer
available to them during trainings. The ROs believe that if training
sessions provided greater opportunity for questions, especially about
specific cases, training would be that much more effective.
We recognize that VBA does need to have some sort of
standardization across ROs in order to maintain consistency. However,
different ROs face different challenges and have different strengths
and weaknesses. Training should have some level of flexibility so that
different ROs can adjust to better prepare employees.
Insufficient New Employee Training
In recent years, VBA has significantly cut the amount of time
dedicated to training new employees. VSRs and RVSRs are given an
initial training period of eight weeks, which is far shorter than new
employees received in the past (often this training took up to a year
to complete). A new employee in Winston Salem expressed that though her
training has been helpful, other employees were not prepared for the
Challenge training yet were still pushed onto the floor upon
completion. She recommends that employees not be rushed into processing
claims until they are fully prepared.
Management does recognize that training is the cornerstone for any
success in reducing the backlog. As reported in St. Petersburg, FL,
they have openly stated that it takes two years to learn these jobs.
Training for experienced employees is weakened by reduced hours and
significant, national shift away from classroom instruction.
VBA is required to provide a significant amount of training on a
weekly basis. However, the time is often not allotted fairly. For
example, the St. Petersburg RO reported that often times, managers will
use ``email training.'' The manager will email pages of reading
material that states the amount of time expected to complete the
training (i.e. 2.5 hours). However, management will inform employees
that they will only approve a fraction of that time (e.g. 30 minutes
for a 2.5 hour curriculum) for them to read and review the materials.
As mentioned in Anchorage, AK, trainers are allowed a maximum of 20
hours of credit per fiscal year to spend preparing for training. VBA
constantly changes procedures due to changes in the law or new
developments in allocating benefits. It is very difficult for trainers
to adequately prepare without the proper preparation time to most
effectively reach employees and explain new procedures.
Workplace Morale
Almost across the board, workplace morale was described as
continually declining and in certain cases, historically low. ROs
described high turnover rates, high levels of stress, fear of
retaliation, and concerns with their own abilities to lower the
backlog. Employees were very concerned about the way they are portrayed
publically due to the increasing publicity surrounding the backlog. The
Los Angeles, CA RO stated: ``As long as the expectation is that the
employees should perform miracles to decrease the backlog, morale will
be low.''
Arbitrary Performance Standards Lower Production and Accuracy
With VBA's recent Transformation and upcoming national rollout of
VBMS, VBA unveiled new performance standards. However, in offices
currently using VBMS, the performance standards have been incredible
difficult to achieve. One office reported that only 20% of their
employees were able to achieve the new performance standards.
Winston Salem, NC described that employees struggle to make
unreasonable performance standards while sandwiched in between pressure
from management and computer systems that too often fail.
Many ROs report VBA's emphasis on production above all else.
Despite recent claims that VBA is placing equal emphasis on quality,
managers are provided many more incentives to increase production
rather than quality. This creates a difficult atmosphere for employees
and lowers morale.
Despite the mandate of Public Law 110-389 and corroboration by IBM,
VBMS has still not conducted a comprehensive, evidence-based,
scientifically designed time motion study to determine how long certain
tasks should take for employees to complete. VBA must develop and
implement this time motion study with regular input from front line
employees and their AFGE representatives before releasing performance
standards for employees. When employees work under achievable
performance standards, accuracy, production and morale will all
increase.
Favoritism in the Promotion Process
On the issues of employee opportunities for career growth, AFGE
member feedback was mixed. ROs consistently reported a level of
favoritism for certain employees who got along well with management as
the leading candidates for promotions, rather than promotions being
based off of performance. As mentioned before, management received
strong incentives for increasing production. Employees also
consistently reported that they did not know of opportunities for
career growth or at the very least, the career path for promotion was
not clearly outlined. Many ROs used the term ``good ol' boys' network''
to describe the opportunities available for possible promotions. The
Winston Salem RO mentioned a glass ceiling in place for minorities and
women.
Lack of Incentives for Internal Promotions
Although RVSRs typically have more experience than VSRs, VSRs in
two ROs (Huntington and Waco) reported that they had little incentive
to try and move up to RVSR positions because they could currently make
more as VSRs. This is because VBA does not accept ``time-in-grade''
when switching careers for timely promotion. For example, if you take
an RVSR position in the middle of a grade, when your career ladder
promotional date is due, VBA restarts it from the date you hired as an
RVSR (rather than the time you spent working as a VSR).
High Turnover
The VSR position experiences very high turnover rates. Highly
skilled and trained VSRs are extremely valuable to the claims process
and play an essential role in lowering any backlog. VSRs are currently
capped at a GS-10 ($45,771-$59,505). Huntington, WV reports that in the
past, there was a position for Senior VSRs (SVSRs), who still worked as
VSRs but had more seniority and played a bigger role in the claims
process. If VBA offered more SVSR positions, this would provide
effective incentives for VSRs to both stay longer and work towards a
higher performance level for promotion. VBA also loses VSRs to other
federal agencies, such as Social Security, who offer higher grades to
their experienced claims processors.
Rewards for RO-Wide Achievement Should Be More Widely Distributed
Throughout the RO
Another consistent theme was that ROs tend to provide superior
performance awards to certain employees while simultaneously excluding
others who were also involved in the process. Often times, in order to
reach a goal for an entire RO, the work must be exceptional from the
Claims Assistants all the way up to the top line supervisors. If ROs
could also receive incentives as a whole, morale could increase and
lower wage employees could be recognized as a major part of the
process.
Weak Management Incentives for Quality
Management incentives are almost always based on production alone.
The Milwaukee, WI RO reported that VACO sets production and quality
targets for offices to qualify for these programs. Production is always
more important since there are several different production categories
that must be met in order for a station to qualify. VA leadership has
outlined its desire to achieve 98% quality; however, VBA must improve
incentives for management to focus on quality and not just on
production levels.
Need Greater Opportunity for Front Line Employee Input into VMBS
Rollout
General Hickey testified at a Senate VA Committee Hearing on March
13, 2013 that employees in the twenty ROs currently using VBMS have the
opportunity to provide feedback to her through weekly conference calls.
While AFGE applauds General Hickey for stating her interest in hearing
directly from front line employees and their AFGE representatives, this
phone call still appears to be a work in progress, and does not include
sufficient input or participation for others besides management. For
example, when AFGE asked the Winston Salem RO to provide the names of
the employees on the call, the only names mentioned were those of
supervisors and managers. Although some front line employees are
participating, General Hickey should encourage greater input from them
by working more closely with AFGE leadership. Without the union
present, many employees may be concerned about retaliation from
management for any negative feedback related to VBMS. General Hickey
has stated clearly that she would like to hear any negative feedback
related to VBMS so that we can all continue to improve the system. With
active, ongoing union involvement, this can accomplished.
It is positive that in Winston Salem, with the consent of the
Director, AFGE has appointed two stewards to be a part of these weekly
calls and we encouraged both of them to engage in conversation about
both the benefits and problems with VBMS.
In terms of dealing directly with the union, General Hickey did
commit to AFGE National VA Council President Alma Lee that she would be
willing to participate in the monthly VBA phone call that the AFGE
National VA Council conducts. This would also present a more meaningful
and effective opportunity for General Hickey to hear from employees who
have direct hands-on experience with VMBS and other Transformation
changes.
Thank you for the opportunity to share the views of AFGE and its
National VA Council.
THE AMERICAN LEGION
In 2010, when Secretary Eric Shinseki laid out the laudable goal of
achieving 98% accuracy on veterans' disability claims with no claim
pending over 125 days, the Veterans Benefits Administration (VBA) had
509,423 claims pending with 39 percent of those claims pending over 125
days. Just this week, on March 18, 2013, VBA's figures show 895,838
claims pending, with a full 70.3 percent of those claims pending over
the 125 day deadline. The Department of Veterans Affairs (VA) is moving
backward, and veterans across America are deeply concerned.
On behalf of National Commander James Koutz and the 2.4 million
veterans of The American Legion, we would like to thank this Committee
for the opportunity to address the critical issue of the claims backlog
affecting veterans across the nation.
The disability claims backlog affects millions of American
veterans. The VA has been aggressively pursuing technological solutions
to attack the backlog and deliver decisions in a timely manner through
the Veterans Benefits Management System (VBMS). However, technological
solutions will not be the sole key to reducing the backlog. The
American Legion believes there are other important, transformative
steps VA must take to fix the system. Three of the most important
changes are:
1. Fix a broken work credit system that currently gives the same
credit for work whether or not it is performed correctly.
2. Develop a system to aggregate common errors in processing and
use this to create a training plan for employees.
3. Hire more veterans to process claims to increase understanding
of the military in those who are interpreting the claims files.
The Work Credit System:
Under the current work credit system, a VA employee gets credit
when a file moves off their desk on to the next station in the chain.
Unfortunately, this system doesn't take into account whether or not the
claim was processed correctly. Error rate continues to be a problem
among VA claims adjudicators. When an error is made processing a claim,
that claim must be appealed. The lengthy appeals process means a claim
that should have been decided in a few months now will take years to be
resolved for the veteran. This keeps the system clogged with work that
could have been removed from the work flow if it had been done
correctly the first time.
Employees are only human. Pressure to move a claim off the desk is
evident because raw volume is the standard VA uses to set productivity
goals. To fix the system would not necessarily require a major
overhaul. It could be as simple as giving credit for when a claim is
finished, but also applying a negative credit or debit when it is
determined work was done in error. If an office finishes 5,000 claims,
but only at an 80 percent accuracy rate, then they would get credit for
4,000 claims.
This is a simple step which would help mold the operational climate
in VA offices. The ability to work hard and accomplish a high work
volume would still be prized; however the ability to work carefully and
achieve high accuracy would then be equally prized. This incentive
structure would help raise VA's accuracy rate to achieve Secretary
Shinseki's goal of 98 percent accuracy.
Common Error Training:
Another factor towards increasing accuracy is improving the quality
of VA's training for claims adjudicators. Software and operating system
solutions such as VBMS are important, but the vast amount of
information VA possesses about veterans' claims should be harnessed for
the purposes of training. With everything shifting to an entirely
electronic operating environment, VA should have unprecedented ability
to track common errors in their claims processing work.
By aggregating common errors found by the Board of Veterans Appeals
(BVA), the Court of Appeals for Veterans Claims (CAVC), and the
internal Systemic Technical Accuracy Review (STAR) VA should be able to
develop effective computer models of where their employees are making
the most mistakes and adjust training accordingly. If the BVA is
consistently finding that Regional Offices (ROs) are not applying
DeLuca factors in rating skeletal-muscular disorders, then VA Central
Office (VACO) should develop training modules for dissemination to
correct the problem. Similarly, if the CAVC finds a consistent pattern
of failure to apply proper evidence standards for Posttraumatic Stress
Disorder (PTSD) cases involving combat zones, refresher material can be
developed and delivered to the ROs to get everyone back on track.
As VA moves towards such a powerful electronic model for the office
environment, they must utilize those tools to be a support to their
employees' decision making skills. Training is already inconsistent
from RO to RO, and developing a centralized plan based on real time
data about where VA can best use their training resources.
Hiring Veterans:
At any given time, less than one percent of the population is
serving in the military. Far fewer people in the population at large
truly understand the sacrifices and day to day realities of military
service. The average person on the street doesn't know the difference
between a Battalion and a Battery, or even that a Battery in a military
context can mean a Company of Artillery soldiers and not the thing that
powers your Smart Phone.
In terms of the claims backlog, military experience is a plus for
claims adjudicators because it enables easy familiarity with the
military records in the claims files. Veterans don't have to spend
extensive time looking up the myriad military acronyms, they just know
that the initials CIB mean a service member has seen combat and thus
the provisions of 38 USC Sec. 1154b apply to their claim.
Veterans have seen unemployment rates two thirds higher than their
civilian counterparts in past years. Boosting the number of veteran
employees at VBA would serve a dual purpose. It would both increase the
institutional knowledge within VBA of the military, and it would reduce
veteran unemployment. To this end, greater work can be done through
vocational rehabilitation programs to encourage veterans to work for
VBA and to ensure they have the skills necessary to be successful
there.
Conclusion:
These three simple steps are by no means an exhaustive solution to
taming the claims backlog. However, they do represent three simple
actions, with a specific scope, which can improve the operational
environment and help VA achieve their goals of accuracy and timeliness.
Nobody, not VA, not Congress, and certainly not the veterans'
community, is satisfied with the current state of the claims system. It
will take work to reduce the claims backlog, but not all of the work
needs to be overly complicated. The American Legion believes that with
a couple of simple initiatives, VA could move forward with their
transformation and help the human side of their offices as their tech
people work diligently on the electronic side of the process.
The American Legion again thanks the Committee for its diligent
attention to the claims process. For additional information regarding
this testimony, please contact Mr. Ian de Planque at The American
Legion's Legislative Division, (202) 861-2700 or [email protected].
IRAQ AND AFGHANISTAN VETERANS OF AMERICA
Statement of Tom Tarantino
Chief Policy Officer, Iraq and Afghanistan Veterans of America
Chairman Miller, Ranking Member Michaud, and Distinguished Members
of the Committee:
Iraq and Afghanistan Veterans of America (IAVA) would like to thank
you for holding this hearing today on this critically important topic,
and for your continued dedication to improving the functioning and
capabilities of the Department of Veterans Affairs (VA) through
oversight. We also appreciate this opportunity to share our views on
finally ending the VA claims backlog.
IAVA is the country's first and largest nonprofit, nonpartisan
organization for veterans of the wars in Iraq and Afghanistan and their
supporters nationwide. Founded in 2004, our mission is to improve the
lives of these veterans and their families. With over 200,000 members
and supporters, we strive to create a country which honors and supports
veterans of all generations.
My name is Tom Tarantino and I am the Chief Policy Officer for
IAVA. I proudly served 10 years in the Army, beginning my career as an
enlisted Reservist, and leaving service as an Active-Duty Cavalry
Officer. Throughout those 10 years, my single most important duty was
to take care of other soldiers. In the military, they teach us to have
each other's backs, both on and off the field of battle. And although
my uniform is now a suit and tie, I am proud to work with this Congress
to continue to have the backs of America's service members and
veterans.
The VA claims backlog has frustrated veterans across the country
since IAVA's inception. After a decade at war, more than half a million
veterans are stuck in the VA disability claims backlog. According to
the VA's own estimates, 70 percent of claims are backlogged by more
than 125 days. The VA has reported that the average wait time was 273
days. But if it's your first claim, like it is for most Iraq and
Afghanistan veterans, it's actually 316 to 327 days. Regionally, the
problem is worse. Veterans returning from Iraq and Afghanistan who live
in major metropolitan areas wait up to twice as long - 642 days in New
York, 619 days in Los Angeles, and 542 days in Chicago.
Disability benefits are designed to fill the gaps in loss of
earnings potential that are caused by injuries sustained during
military service. Long wait times have a devastating impact on veterans
and their families who are trying to successfully transition to
civilian life. After 10 years of war and billions of dollars spent,
veterans are still languishing in a VA disability system that was
obsolete before most veterans of Iraq and Afghanistan veterans were
born. For our brothers and sisters from previous conflicts, this fight
has gone on for decades.
Alone, these numbers would be shocking, but what makes them tragic
is that they represent the stories of real people.
Take the case of Zack McIlwain. Zach is an Army veteran who served
two combat tours in Iraq. He has been waiting nearly three years (973
days) to get all of his disability benefits. Zach tried to be proactive
and filed his initial claim nearly a year before leaving the Army, but
he heard nearly nothing for 18 months. In that time, a service related
injury required surgery at the VA that lead to an infection that
permanently damaged his left hand. This was added to his claim. When
the VA finally ruled, it rated on all but his permanently damaged hand.
Although service connected, the VA said that it lost the paperwork that
related to his surgery, and he would have to appeal and send any new
evidence later. That was a year ago. Zach has the paperwork that the VA
lost and is ready to send it in but has heard nothing from the VA.
And then there is the case of Charles Gardner, a Navy Corpsman
whose first day at Hospital Corpsman School was September 11, 2001.
After six years of honorable service, including a deployment to Iraq
from 2004-2005 with the 5th Marine Regiment, Charles began filing his
VA disability claim toward the end of his term of service. After
receiving conflicting information that initially delayed the filing of
his claim, Charles eventually managed to file the claim correctly. But
since doing so, Charles has been waiting for more than three years for
a decision on his initial submission.
And finally, the story of John Wypyszinski. After serving for
sixteen years in both the Army and the Navy, John filed a disability
claim with the VA only to have his first claim lost. From 2007 through
2009, John pushed and waited for his claim to be completed with no
results. Finally fed up, John retained an attorney and notified local
media about his problem. In the end, the VA regional office that had
been so slow to make progress on John's file for all those years
somehow managed to process his claim and get him his rating within days
of being contacted by a local news affiliate.
These stories are just a few of the nearly half a million voices of
the VA claims backlog. This week IAVA is brining veterans from around
the country to Storm the Hill to call for an end to the VA claims
backlog. Although the VA is in the process of modernizing the claims
system, the backlog continues to grow with no end in sight. Although
well intentioned, it is clear that the VA can't solve this problem on
its own. We must utilize all the resources and ingenuity that America
has to offer to break the claims backlog and keep the promise we made
to the millions of veterans who have sacrificed to defend our nation.
The time to act is now. IAVA is calling on President Obama to
establish a presidential commission to end the claims backlog. We are
asking the members of the committee to join us in this call while also
continuing to investigate the causes of the backlog and to hold the
VA's leadership accountable. Veterans did not hesitate or delay in
answering the call to serve their country. Now that they have returned,
we owe it to them to answer their call to end the backlog.
Thank you for the opportunity to offer the views of our membership
on this topic of critical importance, and we look forward to continuing
to work with you and with the VA to improve the lives of Iraq and
Afghanistan veterans and their families. Thank you for your time and
attention.
NATIONAL ORGANIZATION OF VETERANS' ADVOCATES
Prepared Statement
Michael R. Viterna, President of NOVA
Contact Information:
National Organization of Veterans' Advocates, Inc.
1425 K Street, NW, Suite 350
Washington, DC 20005
(202) 587-5708
www.VetAdvocates.org
The National Organization of Veterans' Advocates, Inc. (NOVA)
thanks Committee Chairman Miller and Ranking Member Michaud for the
opportunity to testify about the disability claims process at the
Department of Veterans Affairs (VA). NOVA is honored to share our views
for this hearing, ``Focusing on People: A Review of VA's Plans for
Employee Training, Accountability, and Workload Management to Improve
Disability Claims Processing.''
NOVA is a not for profit 501(c)(6) educational membership
organization incorporated in the District of Columbia in 1993. NOVA
represents nearly 500 attorneys and agents assisting tens of thousands
of our nation's military Veterans, their widows, and their families
obtain benefits from VA. NOVA members represent Veterans before all
levels of VA's disability claim process. This includes the Veterans
Benefits Administration (VBA), the Board of Veterans' Appeals (BVA or
Board), the U.S. Court of Appeals for Veterans Claims (Veterans Court
or CAVC), and the U.S. Court of Appeals for the Federal Circuit
(Federal Circuit). In 2000, the CAVC recognized NOVA's work on behalf
of Veterans when the CAVC awarded the Hart T. Mankin Distinguished
Service Award.
On April 18, 2012, NOVA testified before this committee and
addressed several issues:
1. The need for Access to Veterans Electronic Records by Private
Practitioners
2. Entering Information Sent to VA in a Correct and Timely Manner
3. Improving Access to VBA Points of Contact for Private
Practitioners
4. Decreasing Blocked Calls and Incorrect Information Given by VA
These issues all relate to VA's workload management and attention
thereto will improve disability claims processing by allowing VA to
dedicate employee resources to disability claims processing rather than
responding to status inquiries and record copy requests and will help
assure accuracy of incoming and outgoing information. Yet, a year after
its testimony, NOVA can report no meaningful progress in any of these
areas despite repeated attempts to work with Agency personnel through a
variety of channels. NOVA would like to summarize and clarify its
observations and concerns in these areas as relates to accredited
attorneys and agents and the Veterans they represent.
1. Access to Veterans Electronic Records (VBMS)
On two occasions last year, NOVA formally raised its concerns to
Congress relating to the need for timely, accurate, and complete access
to a VA claimant's file by a Veteran's authorized representative. This
is absolutely vital in order to protect the rights of our Veterans and,
without question, will positively contribute to the improvement of
claims processing.
Congress has proscribed that ``[a]ll files, records, reports, and
other papers and documents pertaining to any claim under any of the
laws administered by the Secretary . . . shall be confidential and
privileged, and no disclosure thereof shall be made except as provided
in this section.'' See 38 U.S.C. Sec. 5701(a). The statute mandates
thereafter that the Secretary ``shall make disclosure'' of these
protected VA records to ``a claimant or duly authorized agent or
representative of a claimant as to matters concerning the claimant''
when such disclosure would not be injurious to the claimant. See 38
U.S.C. Sec. 5701(b).
The information and evidence that serves the basis of a Veteran's
claim comprises the VA claims file as we know it today. For the vast
majority of our Veterans, this file is in paper format and, as such, is
perhaps the single impediment to accurate and timely VA claim
processing.
Access by a claimant to his or her VA case file heretofore has been
possible only by visiting the VA Regional Office (VARO) by appointment
to review the file or by requesting a paper copy of that file. In our
experience, neither process is effective. Request for paper copies
result in response delays of many months, with 6 to 12 months or more
being common. The records are copied individually and by hand and the
result is less than optimal. Forms are copied in no order whatsoever,
are provided out of sequence with other, nonrelated documents
intermingled within another's pages, are often upside down, with
backside information lacking, or are illegible due to poor copying
techniques or VARO overprinting of facility identification markings.
Worse, portions of the record are frequently missing and, in many
cases, contain confidential and privileged records from other VA
claimants unrelated to the case at hand. Accordingly, the information
provided is less than optimal for assisting the representative in the
claims development, adjudication and appeals processes.
The Veterans Benefit Administration (VBA) claims file is still in
paper format for nearly all Veterans. Health records, created and
maintained by the Veterans Health Administration (VHA), to the
contrary, are presently and have been in electronic format for some
time. The paper claims file is a dinosaur that is at the heart of VA's
inability to improve disability claim processing. Its very existence
results in manpower, copier and postage expenses that are entirely
unwarranted in today's technologically advanced society. Worse, a paper
system invites inaccurate information through misfiling, impedes a
Veteran's ability to obtain timely information regarding his or her
claim so he or she can assist in the claims development process, and
represents a misuse of limited VA resources. Other government agencies,
like the Social Security Administration (SSA), have long-ago recognized
the inherent difficulties and expenses of a paper based system and have
effectively transitioned to a secure, on-line electronic format,
entitled ``Appointed Representative Suite of Services'' (ARSS).
VBA's e-Benefits system, also known as the Veterans Benefits
Management System (VBMS), was to address the deficiencies noted above
but the progress from NOVA's perspective has been dismal, with no
viable solution in sight. This is the top complaint of NOVA members who
work with Veterans every day. The lack of access undermines our
Veterans' due process and property rights but also directly contributes
to the delays in claims processing.
VA has provided electronic access to Veteran Service Organizations
(VSOs) but has yet to even define what files will be accessible or what
steps must be taken to grant this same access to private attorneys and
agents despite the clear advantages for it to do so. For instance, VHA
record access has yet to be defined, much less assured. Yet, NOVA has
been advised that HVAC committee staff were recently given a briefing
by VA officials where they were told that private attorneys and agents
presently have access. This is not true. What is true is VA has not
determined how access will be provided and what information is to be
included. NOVA has been informed that security training will be
required but that remains to be undefined further. NOVA has also been
told that everyone will be required to have PIV cards and must purchase
card readers to enable private access, after undergoing fingerprinting
and security background checks. Apparently, VA's assertions of modeling
VBMS after the ARSS system successfully used by SSA are not to be taken
seriously. Rather, it has chosen to utilize its limited resources in
needlessly developing a complicated process for access that only helps
prolong the processing of VA claims.
2. Timely Entry by VA of Veteran Claim Information
It has been the experience of NOVA's members that there are
substantial time delays between receipt of a claim inquiry, or the
submission of evidence, and when it is available to VA claim decision
makers. Besides the usual delays associated with receiving and
processing the mail, an additional delay is incurred because VA must
then determine if it can respond to the inquiry or accept the evidence
provided. If the inquiry or evidence submitted is not from the VA
claimant, then VA must validate that the information was obtained from
the Veteran's authorized representative. The Veteran conveys his/her
authorization by appointing a representative through submission of a VA
Form 21-22a. Yet, this appointment is meaningless unless and until VA
has taken the effort to enter that information into its system. Such
entry in most cases takes several months and much longer many times.
NOVA has been informed that these forms are not being submitted timely
because no specific VA employee has been directed to assume this
responsibility and no work credit is given for this process.
Consequently, the form is submitted by whomever, whenever it can be
worked in and additional work effort is required either returning the
materials submitted or in making further inquiry to verify that the
representative has been properly appointed.
Access to a fully functional on-line system, as that employed by
SSA, would permit the electronic submission of correspondence and
evidence directly to the file without the delays inherent with a paper
driven system. This process would help assure that information is filed
in the correct Veteran's file. Moreover, it would eliminate the need
for VA to manually receive and process the appointment of a
representative. Such access represents considerable time savings to VA,
allowing them to devote resources instead to claims development and
processing.
3. Access to VBA Points of Contacts
Private representatives have no meaningful access to VBA contacts.
Last year we noted that Attorney Fee Coordinators (AFC) at VBA Regional
Offices may serve as liaisons with attorneys and agents, many of whom
are NOVA members. In most cases, AFCs are cooperative and helpful to
NOVA members, providing prompt and accurate status updates on Veterans'
claims; but in many cases, like the Detroit VARO, the AFC has been
instructed to restrict assistance to fee related issues only. Instead,
the private representative must waste additional time by submitting
written inquires that take weeks or months, if ever, for a vague
response as to claim or appeal status. Alternatively, a representative
may call the VA ``800'' system but those contacts, without exception,
provide even less specific information and afford no guidance on what
may be needed to move a claim forward. This is also true for telephonic
contact to the Board of Veterans' Appeals. More promising, but no more
effective, is an electronic inquiry though VA's Inquiry Routing &
Information System (IRIS), which provides email and telephonic
responses to a Veteran's representative. Again, the responses are
extremely vague and most often result in a simple recitation of the
adjudication history i.e., date of claim, notice of disagreement,
substantive appeal filing, etc. Too often the response is denied
because a power of attorney appointing the Veteran's representative has
not been electronically recorded, despite the fact the form had been
filed months earlier. Typically, the response is too vague to be of
value i.e., awaiting a decision, awaiting a medical examination,
awaiting Decision Review Officer Review, etc.
Access to a fully functional on-line system, as that employed by
SSA, would permit timely access to information about a Veteran's claim,
such that evidentiary deficiencies or responses could be addressed by
the claimant without delay. Moreover, such access represents
considerable time savings to VA, allowing them to devote resources
instead to claims development and processing.
4. Decreasing Blocked Calls and Incorrect Information Given by VA
As with the preceding issues, on-line access to Veteran file
information will provide accurate, real time information that will
obviate the need for telephone inquiries which will, in turn, allow VA
to dedicate resources to claims development and processing.
In summary, VA's timely transition to a fully electronic claims
files system that assures full access to all stakeholders, Veterans and
representatives alike, is the single most important factor in improving
claims processing. VBMS, when and if fully implemented, will allow VA
to allocate resources in a meaningful manner and reduce the challenges
of an overburdened disability claims processing system.
In conclusion, the matters we testified about in April 2012 still
continue a year later, with little or no progress. NOVA has met with VA
officials on numerous occasions to try to resolve these and other
issues with limited success. The training of individuals within VA
needs to address these and other similar issues that will aid Veterans
in obtaining their rightful benefits. A cultural change is necessary
within VA.
As always, NOVA stands ready to assist the Committee or VA in
whatever way possible to further improve and enhance the systemic
issues that negatively affect the lives of our Veterans and their
families.
We thank you for this opportunity to provide our testimony.
PARALYZED VETERANS OF AMERICA
Chairman Miller, Ranking Member Michaud, and members of the
Committee, Paralyzed Veterans of America (PVA) appreciates the
opportunity to submit a statement for the record concerning the
Department of Veterans Affairs' (VA) performance with processing
claims. We are particularly pleased to see the focus you have placed on
VA's plans for employee training, accountability, and workload
management to improve disability claims processing. This issue deserves
a great deal of oversight as the number of veterans waiting on ratings
decisions continues to grow.
Historically the Veterans Benefits Administration (VBA) was funded
based on workload demands and staffing budgets were predicated based on
the perceived need to provide quality service to veterans. The number
of authorized Full-Time Equivalent Employees (FTEE) was based on
anticipated workload and could also include additional services that
were deemed to be of value to veterans. The allocation of resources, as
funded by Congress, was based on the need to provide adequate and
timely services. As this paradigm shifted to a more capricious
budgetary process which formulated FTEE requirements based on available
funding rather than workload demands, the dynamics of claims processing
became inextricably intertwined with issues unrelated to the quality of
service.
The clamor that then accompanied the steadily increasing backlog in
the number of claims quickly garnered the attention of Congress, and
the previously esoteric internal affairs of the VA quickly became the
object of external review. As the pressure on VA increased to reduce
the backlog of pending claims, employees were strongly encouraged to
maximize their productivity. The short term dividends achieved in part
by reduced training time were followed by long term losses fostered by
lack of expertise. As the error rate climbed, a new clamor loomed; this
time to improve quality. By this point the VA was forced to defend a
situation that it did not have sole responsibility in creating. Every
oversight hearing conducted by Congress or other government agencies
has basically centered on finding fault, as if success could be equated
with determining why something failed. This then fostered a culture in
VA of ``it's OK if something failed, as long as it's not my fault.''
The VA felt increasing pressure from Congress to demonstrate
improvements in the overall accuracy of claims processing. This
pressure elicited responses from VA top leadership from the Secretary
on down. The cry from veterans' service organizations merely echoed the
universal agreement that change was essential. While no one disagreed
on the requirement for accuracy, there were other components that
entered into the equation.
We live in a highly sophisticated world of technology where
ubiquitous sources of statistical data lead us to conclusions that are
not always reinforced by logic. Errors are often evaluated by the scale
on which they deviate from the established process. While the
traditional process can have great value, it cannot summarily dismiss
the value of applied logic and common sense. VA employees who know
their jobs well should not live in fear of being punished for
exercising judgment in the processing of VA claims. The adjudication of
VA claims must not be limited by the application of algorithmic
technolologies. If this were the case, we would not need a Board of
Veterans' Appeals or the Court of Appeals for Veterans Claims.
While the Department of Veterans' Affairs has made great progress
in streamlining their overall system of claims processing, they have
overemphasized the role of technology and have underestimated the
capacity of individual innovation. Technology is a tool that offers
great advantage to a competent work force. It is not a substitute for
qualified employees. While VA is paving the way for the future with
their implementation of the Veterans Benefits Management System (VBMS),
they are missing the opportunity to empower their people by fostering
and recognizing creativity.
We have to ask how VA Regional Offices like Baltimore and Oakland
were allowed to get to the point where any semblance of quality
workmanship was difficult to recognize? Could it be that people in
these geographic areas are less qualified? While this question is
obviously rhetorical, it does lend credence to the probability that the
likely root cause of the problem can be traced to poor management.
First line supervisors are responsible to evaluate those working
under their direction and to take whatever corrective action is deemed
necessary to achieve an acceptable level of employee performance. This
responsibility continues up the supervisory chain and ultimately rests
with the Director of a Regional Office. All employees are challenged to
do the best they can with the resources that are available to them.
When forced to work in an environment that is far from ideal,
innovation and empowerment become more important than ever.
We would offer an example of a situation PVA is currently facing.
PVA is handling the claim of a veteran for amyotrophic lateral
sclerosis (ALS) where the veteran had deteriorated rapidly and was
rated as R-2, which is the highest possible VA rating. The rating was
completed in January and as of this writing, has not been promulgated.
After numerous inquiries, PVA's Benefits staff was told that since the
retroactive payment was in excess of $25,000, a third signature was
required, and that there was no one in the office that week that could
authorize this payment. While this determination was made by a very
senior level employee who was ``following the rules,'' we would argue
that the delay was needless. The obvious purpose of the $25,000 rule is
to prevent costly errors that could easily occur in large retroactive
benefits payments. In this case, however, the veteran's R-2 rating
resulted in a $5,000 monthly increase for the previous six month
period. Simple math shows that the veteran should receive $30,000 as a
retroactive payment. There really isn't any potential vulnerability in
this instance and the high level supervisor in question could have
considered the intent of the audit procedure and assumed the risk of
taking an appropriate action under the circumstances.
Generally speaking, procedures are set in place for a reason, but
the application of common sense must somehow be facilitated. Employees
must be trained and empowered to follow the intent of established
practices. The Hippocratic Oath, ``Do no harm,'' should be valued as
much by VBA as it is by VHA. Quality cannot be determined by an overlay
approach of the process
The bottom line is that VA was forced to react to mounting
criticism of poor quality and they ultimately relied too heavily on the
rules rather than on results. The only resolution that we see to this
issue is a more objective measure of quality that focuses on results
more than procedural issues. VA employees should be recognized for
creativity and innovation on how they comply with the intent of the
law. Quality reviews should include a focus on claims processing which
objectively evaluates how a claim was processed from start to finish as
opposed to reliance only on incremental reviews of each of the multiple
components of the process.
Paralyzed Veterans of America appreciates the Committee's continued
concern with the massive problem that the VA faces in getting claims
decisions done in a timely manner while ensuring that they are done
right the first time. With the Committee's diligent oversight and the
VA's willingness to change, we believe VBA can achieve Secretary
Shinseki's goal of eliminating the claims backlog.
Thank you again for the opportunity to submit a statement for the
record. We would be happy to take any questions.
Information Required by Rule XI 2(g)(4) of the House of Representatives
Pursuant to Rule XI 2(g)(4) of the House of Representatives, the
following information is provided regarding federal grants and
contracts.
Fiscal Year 2013
No federal grants or contracts received.
Fiscal Year 2012
No federal grants or contracts received.
Fiscal Year 2011
Court of Appeals for Veterans Claims, administered by the Legal
Services Corporation--National Veterans Legal Services Program--
$262,787.
Questions For The Record
HVAC Majority Members Questions to VBA
Chairman Miller: Of VBA's approximate 20,000 positions, how many
employees were fired in the year 2012?
Mr. Huelskamp: Provide the list of bonuses (amount, recipient,
region) awarded to regional managers over the past 5 years. (VBA noted
that this would be provided for years up to and including 2011, as the
bonuses for 2012 have not yet been finalized)
Mr. Huelskamp: We heard from GAO that in certain parts of the
agency there is data falsification occurring. How many employees have
been penalized or punished for falsifying data in the last three to
four years?
Mr. Huelskamp: Provide budget information as to how money is spent
on VA conferences and those types of events.
Chairman Miller: Review a situation that was presented to us from
the Jackson, MS RO, regarding an 11 year old remanded claim that was
reported to be sitting with RO; please respond. Under Secretary Hickey
requested the name and contact information, which is veteran Richard C.
Lancaster, C-File # 28150889.
Chairman Miller: Has VA received any reports from employees that
any management has advised or ordered employees to process certain
claims first to inflate the RO numbers? Has VA received any reports
from employees that any management has advised or ordered employees to
``accidentally'' clear old claims for station credit and then
reestablish the claims under a 930 end product, which is not tracked by
central office?
Mr. Coffman: In accordance with the VBA's goals, we have heard
VBA's target for 2015 but in terms of interim goals, provide the
specific number as to what you project the backlog to be at in a year
(as of early of 2014).
Mr. Bilirakis: Specific to the St. Pete RO, please specifically
provide information as to how VA will address St. Pete RO's stated need
for $2.5 million in overtime funds for FY 2013. Will $2.5M be provided
to the St. Pete RO for overtime?
Chairman Miller: In e-Benefits, how soon after uploading documents,
such as medical records, will the system reflect that the materials/
information was received?
Chairman Miller: Noting a 2015 laudable paperless goal, we received
testimony a few weeks ago regarding the individual electronic health
record and it now appears that DoD and Va are going on divergent paths.
If Dod and VA do not cooperate on creating the single record, how is
that going to impact the ability to adjudicate claims?
Responses From VBA to HVAC Majority Members Questions
Chairman Miller: Of VBA's approximate 20,000 positions, how many
employees were fired in the year 2012?
Response: For this question, VBA defined ``fired'' as any VBA
initiated termination actions on employees based on performance,
conduct, delinquency (attendance/dereliction of duty/refusing
reassignment), removal during probationary period, and/or failure to
meet suitability requirements. Please see the chart below for the
requested data.
----------------------------------------------------------------------------------------------------------------
Fiscal Year VBA Employees ``fired''
----------------------------------------------------------------------------------------------------------------
2000............................................................ 74
----------------------------------------------------------------------------------------------------------------
2001............................................................ 105
----------------------------------------------------------------------------------------------------------------
2002............................................................ 152
----------------------------------------------------------------------------------------------------------------
2003............................................................ 61
----------------------------------------------------------------------------------------------------------------
2004............................................................ 68
----------------------------------------------------------------------------------------------------------------
2005............................................................ 43
----------------------------------------------------------------------------------------------------------------
2006............................................................ 90
----------------------------------------------------------------------------------------------------------------
2007............................................................ 128
----------------------------------------------------------------------------------------------------------------
2008............................................................ 152
----------------------------------------------------------------------------------------------------------------
2009............................................................ 180
----------------------------------------------------------------------------------------------------------------
2010............................................................ 283
----------------------------------------------------------------------------------------------------------------
2011............................................................ 138
----------------------------------------------------------------------------------------------------------------
2012............................................................ 126
----------------------------------------------------------------------------------------------------------------
2013 (through Feb 28)........................................... 37
----------------------------------------------------------------------------------------------------------------
Mr. Huelskamp: Provide the list of bonuses (amount, recipient,
region) awarded to regional managers over the past 5 years. (VBA noted
that this would be provided for years up to and including 2011, as the
bonuses for 2012 have not yet been finalized)
Response: The 56 regional offices are separated into four areas,
and each Area Director is responsible for oversight for his/her
respective regional office. Information on bonuses for Area and
Regional Office Directors is attached.
Mr. Huelskamp: We heard from GAO that in certain parts of the
agency there is data falsification occurring. How many employees have
been penalized or punished for falsifying data in the last three to
four years?
Response: Yes, please see the chart below for the number of VBA
employees disciplined each fiscal year for falsifying data. These
counts include a variety of falsified data, ranging from information
related to attendance/leave to data for production.
----------------------------------------------------------------------------------------------------------------
FY Employees Disciplined
----------------------------------------------------------------------------------------------------------------
2010............................................................ 13
----------------------------------------------------------------------------------------------------------------
2011............................................................ 30
----------------------------------------------------------------------------------------------------------------
2012............................................................ 55
----------------------------------------------------------------------------------------------------------------
FYTD 2013....................................................... 15
----------------------------------------------------------------------------------------------------------------
Mr. Huelskamp: Provide budget information as to how money is spent
on VA conferences and those types of events.
Response: Please see the attached report for VBA's conference
spending in the first quarter of FY 2013.
Chairman Miller: Review a situation that was presented to us from
the Jackson, MS RO, regarding an 11 year old remanded claim that was
reported to be sitting with RO; please respond. Under Secretary Hickey
requested the name and contact information, which is veteran Richard C.
Lancaster, C-File # 28150889.
Response: Pending with VBA
Chairman Miller: Has VA received any reports from employees that
any management has advised or ordered employees to process certain
claims first to inflate the RO numbers? Has VA received any reports
from employees that any management has advised or ordered employees to
``accidentally'' clear old claims for station credit and then
reestablish the claims under a 930 end product, which is not tracked by
central office?
Response: VA takes data integrity very seriously. Any reports from
employees or stakeholders which imply that a regional office may be
falsifying data are investigated immediately. Certain claims can be
expedited based on various factors, to include if the Veteran is
homeless, terminally ill, or facing financial hardship. The 930 end
product is used to review cases that may require correction or
referral. This end product is tracked at both the Central Office and
regional office level.
Mr. Coffman: In accordance with the VBA's goals, we have heard
VBA's target for 2015 but in terms of interim goals, provide the
specific number as to what you project the backlog to be at in a year
(as of early of 2014).
Response: Pending with VBA.
Mr. Bilirakis: Specific to the St. Pete RO, please specifically
provide information as to how VA will address St. Pete RO's stated need
for $2.5 million in overtime funds for FY 2013. Will $2.5M be provided
to the St. Pete RO for overtime?
Response: The Office of Field Operations distributes overtime
funding allocations quarterly, based on RO performance, staffing,
individual missions and workload levels. While overtime funding is
constrained by the overall funding level in the VBA budget, every
effort is made to fund individual ROs at a level that is sufficient to
support their accomplishment of the National mission. Fiscal year to
date, the St. Petersburg RO has spent approximately $868,000 on
overtime and will receive $450,000 to start Quarter 3. RO balances are
regularly monitored during the quarter, and individual RO requests are
evaluated and funded on a case-by-case basis, as funding allows.
Chairman Miller: In e-Benefits, how soon after uploading documents,
such as medical records, will the system reflect that the materials/
information was received?
Response: When a user uploads documents into eBenefits, they are
immediately available to field personnel for access within the Veterans
Benefits Management System, and the system will reflect a new mail
indicator.
Chairman Miller: Noting a 2015 laudable paperless goal, we received
testimony a few weeks ago regarding the individual electronic health
record and it now appears that DoD and VA are going on divergent paths.
If DoD and VA do not cooperate on creating the single record, how is
that going to impact the ability to adjudicate claims?
Response: The Department of Veteran Affairs (VA) and the Department
of Defense (DoD) are not moving away from a joint, integrated
electronic health record. This is still the plan and while the strategy
used to accomplish this goal has changed, the end goal remains the
same.
HVAC Minority Members Letter and Questions to VBA
Letter and Questions from Rep. Michael H. Michaud, Ranking Democratic
Member
April 3, 2013
The Honorable Eric K. Shinseki
Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
In reference to our Full Committee hearing entitled, ``Focusing on
People: A Review of VA's Plans for Employee Training, Accountability,
and Workload Management to Improve Disability Claims Processing'' that
took place on March 20, 2013, I would appreciate it if you could answer
the enclosed hearing questions by the close of business on April 30,
2013.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all Full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Jian Zapata at [email protected]. If you have any questions,
please call (202) 225-9756.
Sincerely,
Michael H. Michaud
Ranking Democratic Member
MHM:jb
People Questions
1. Are there certain types of medical conditions that could
possibly be automated in VBMS for immediate verification and payment?
Please provide the specific medical conditions if so.
2. In the hearing, it was suggested that the productivity of VBA
employees had gone down over time. Does VBA believe this to be
accurate?
3. Does VBA believe that the complexity of an individual claim has
gone up and therefore the time required to adjudicate an individual
claim has gone up?
4. Could training be better focused if individual VARO's focused on
specific medical conditions versus all medical conditions that a
veteran might apply for?
5. AFGE has provided us with training recommendations in their
Statement for the Record. They raise some important points, such as:
a. How much training is provided to new employees prior to allowing
them to process cases?
b. In addition to the Change Management Agents that have been
placed at each RO, how is employee input and other feedback included to
improve current training or to develop new training programs?
c. How often are live cases used in trainings?
6. AFGE's statement also suggests implementing a time motion study
to better determine appropriate performance standards. Has VA explored
conducting such a study?
7. AFGE points out that management incentives are largely based on
quantity of production. How are incentives calculated to also take into
account quality of production?
8. The Committee was informed that the VBA does not have a unified
system for aggregating and analyzing the results of both the coach
reviews and the STAR reviews.
a. What has been done to strengthen the Systematic Technical
Accuracy Review (STAR) program and to create a more unified review
system that ensures proper follow-up, remediation, and training?
9. Have there been any updates or improvements to the work credit
system to also focus on accuracy?
10. In consideration of moving into a new processing system, when
does VBA plan to reconsider the work-credit system?
Process Questions
1. Does it make sense for VA, in a paperless processing system, to
have high performing stations specialize and focus on the difficult
claim types?
2. Does VBA believe that focusing on a ``claim'' is an effective
way to evaluate their workload? Is there a more accurate way to
estimate the actual workload and to distribute and specialize it?
3. What proportion of all claims in the past fiscal year had a
medical condition that was paid in advance of the complete adjudication
of the claim?
a. What proportion of claims at the Togus VARO, in the past fiscal
year, had a medical condition that was paid in advance of the complete
adjudication of the claim?
b. What proportion of claims at the Los Angeles VARO, in the past
fiscal year, had a medical condition that was paid in advance of the
complete adjudication of the claim?
4. What factors inhibit a ``pay as you go'' process in a paper
based adjudication model?
a. Will all of these concerns be eliminated in a paperless
processing system?
b. How will VBA be better situated to pay medical conditions as
they are completed?
5. Under the Fully Developed Claims program (FDC) program:
a. How many are new claims vs. an increase in ratings?
b. Currently, claimants are unable to go use the FDC process if
they have other claims pending adjudication that aren't in the FDC
program. Has VA explored changing this?
c. What sort of incentives is VA exploring for VSO, State, and
County partners to increase FDC submissions?
d. Is there any way that VSO's can assist in providing all of the
information required for an instantaneous benefit decision and payment
for certain types of medical conditions or presumptions? For instance,
could a VSO National Service Officer certify that a Vietnam veteran was
in country and had Ischemic Heart-Disease and then subsequently provide
VBMS with the required information for an immediate approval?
6. I understand that 71 of 81 individual Disability Benefits
Questionnaires (DBQs) are available to private physicians. What 10 are
still unavailable and why?
7. In testimony at a previous hearing, the American Legion suggests
a place on each DBQfor a doctor to state a critical nexus opinion, or
an assessment of the likelihood any present disability is related to a
veteran's service experience. Has this suggestion been explored?
8. Can you provide an update on what has been done to strengthen
the quality review process for DBQs to verify private physicians, track
disability ratings that used DBQs, store completed DBQs electronically,
and other fraud prevention controls?
9. Can you provide an update on the revision of the VA Schedule for
Rating Disabilities and timeline for when the review of the 15
different body systems will be complete?
10. What challenges do you face in regards to receiving electronic
Service and Personal records from the National Guard or Reserves for
the purposes of adjudicating claims?
a. Does both the Guard and Reserve a central location in which
these records are stored?
b. Does both the Guard and Reserve have a standardized format in
which they complete and store these records?
c. What challenges does this present to VA in trying to adjudicate
these men and women's claim in a timely fashion?
d. Are VA employees receiving specific training on dealing with the
records and attendant problems of Guard and Reserve members?
11. I understand that some of the veterans' service organizations
had issues with Simplified Notice Letters being confusing and overly
generic.
a. Has VA worked with the VSOs to fine tune some of the SNL
language so that they provide sufficient and specific information to
inform veterans about the reasons and basis for rating decisions?
Technology Questions
1. I understand that we are contracting out the work to scan
documents into VBMS, but there are concerns that pages are sometimes
not in order, that pages are missing, or that files contain pages of
information from other veterans.
a. What quality metrics are we holding these contractors up to and
how are the various contractors performing?
2. In regards to latency issues with VBMS, is this due to data
storage in one location?
3. The National Organization of Veterans Advocates points out that
currently, claimants are only able to access their case files by either
requesting a paper copy, which often takes months, or by visiting the
VA Regional Office by appointment.
a. Once VBMS is fully implemented, will veterans have electronic
access to look at their own case files?
4. I understand that VSOs have electronic access VBMS.
a. Are the VSOs able to access all files of the veteran they are
working with?
b. Will private attorneys be able to have access down the line?
5. Blinded Veterans of America raises the issue that VA has had
internally identified American Disabilities Act (ADA) Disability
Section 508 Compliance issues in the past 18 months and one of the
significant barriers for blinded veterans trying to file or track their
claims electronically is lack of accessibility.
a. What sort of resource planning for addressing ADA 508
Accessibility for FY 2014 is being made now and for FY 2014?
b. What is the time frame for fixing eBenefits Program to meet ADA
508 Access?
Implementation Questions
1. What is being done to prepare for the estimated 774,000 claims
(from FY 2013 to FY 2015) that are anticipated as a result of the
Veterans Opportunity to Work Act/Veterans Employment Initiative and the
Camp Lejeune legislation?
2. What sort of outreach and public education is being conducted to
educate veterans on all of these new initiatives?
3. Can VBA please compare the performance of the paper based model
versus the new transformation model at stations that have been in VBMS
and the Transformation Organization Model since January? In particular,
can VBA clearly identify and articulate increases in efficiency and the
accuracy of claims processing.
Questions from Rep. Dina Titus
1. General Hickey, Reno is taking 478 days on average to complete a
claim. While it sounds like VA is working hard to move towards an
electronic system the numbers continue to head in the wrong direction.
a. Do you have any information that you can share with the
committee regarding the transformation that indicates that your team is
heading in the right direction?
b. When can we expect the Reno VA Regional Office to begin reducing
their average time?
2. General, can you please explain to me how you have determined
that a VA Regional Office should receive the station enhancement
training and have you considered Reno?
3. General Hickey as I am sure you know over 240,000 of the claims
in your inventory is stuck in a holding pattern known as awaiting
evidence. 25% of those claims have been awaiting DoD personnel records
for more than 60 days and 13% have been waiting for more than 90 days.
In addition, Service Treatment Records take on average 55 days to be
received. This is a long time for VA to be waiting for information from
DoD and leads to delays for our Veterans.
4. Now, in your testimony before the Senate you indicated that VA
and DoD had reached an agreement that DoD would provide you with
certified to be complete medical and personal records. You also
indicated that this would not reach full operational capability until
2017, can you further elaborate on this timeline and what was agreed
to?
a. What would occur if DoD does not honor this agreement? What
impact would that have on the backlog in your opinion?
b. Do you have any other concerns in regards to receiving
information from other federal agencies?
5. In a previous Subcommittee hearing last Congress, we examined
how veterans who suffer from Military Sexual Trauma (MST)-related PTSD
have only a 1 in 3 chance of having their claims approved.
a. I understand that VA policy requires that Veterans who have MST-
related PTSD be informed that they may use information from sources
other than their service records to establish credible evidence of the
stressors from MST they have endured before VA can deny their claim. In
your observation of MST cases, is this being done?
b. Has VA looked at creating a separate lane for MST claims?
c. What more do you think VA can do to improve training of its
employees who adjudicate MST claims so prevent improper denial for lack
of evidentiary documentation?
6. Can VBA please provide a detailed roadmap of how it expects to
reach its goal of no veteran's claim pending longer than 125 days with
98% accuracy by 2015. This should include a detailed analysis of each
of the 56 VA regional offices with the productivity and benchmarks they
expect from each of these offices to reach the goal and reduce the
backlog.
Responses From VBA to HVAC Minority Members Questions
Questions from Rep. Michael H. Michaud, Ranking Member
People Questions
Question 1: Are there certain types of medical conditions that
could possibly be automated in VBMS for immediate verification and
payment? Please provide the specific medical conditions if so.
Response: The Veterans Benefits Administration's (VBA) goal is to
turn the information contained in the Department of Veterans Affairs'
(VA) Disability Benefits Questionnaires (DBQ) into data that will drive
calculator-based engines in the Veterans Benefits Management System
(VBMS) to provide automated decision recommendations on levels of
disability. For example, objective results of hearing exams could be
entered into an automated decision process. Such automation would
improve decision consistency and accuracy as well as reduce processing
time. The development of automated decision-support capabilities is a
priority effort in the future.
Question 2: In the hearing, it was suggested that the productivity
of VBA employees had gone down over time. Does VBA believe this to be
accurate?
Response: The productivity per employee was calculated as rating
claim completions per direct full-time equivalent employee (FTEE) on
the chart presented at the hearing. This data was taken from VA's
budget. This measure does not provide the full picture of VBA's current
workload and the productivity of our employees. As mentioned at the
hearing, today's Veterans are claiming many more disabilities (between
12 and 16 for recently separating Servicemembers), resulting in an
increase of medical issues rated per claim and adding to the complexity
of the process and the time to complete the claim.
Productivity when measured by medical issues rated per claim shows
that the number of issues decided per FTEE is increasing. In the first
quarter of fiscal year (FY) 2008, VBA employees completed approximately
3.2 issues per each claim. In the fourth quarter of FY 2010,
productivity improved to 3.8 issues per each claim. This represents a
13 percent increase in issue-based productivity. During FY 2011,
productivity on both issues and claims decreased due to the intensive
review and adjudication of the Agent Orange claims, which are subject
to court oversight pursuant to the Nehmer court order.
Issue-based productivity reached a 4-year high in the fourth
quarter of FY 2012. At the issue level, productivity was up by 31
percent over the first quarter of FY 2008 and 17 percent over the
fourth quarter of FY 2010. The net issues per completed claim also
increased to over four issues per claim.
Question 3: Does VBA believe that the complexity of an individual
claim has gone up and therefore the time required to adjudicate an
individual claim has gone up?
Response: Yes, there has been an increase in claims complexity. As
described in response to question 2, claims decided now contain more
than four issues per claim on average. A March 2013 survey indicates 18
percent of pending original claims for compensation have 9 or more
medical issues claimed and nearly 9,000 of them have 20 or more medical
issues. VBA expects that the trend of increasing medical issues per
claim and the concomitant complexity of these claims to continue to
increase.
Question 4: Could training be better focused if individual VARO's
focused on specific medical conditions versus all medical conditions
that a veteran might apply for?
Response: VBA has already consolidated claims for specific types of
work (e.g., radiation claims, mustard gas claims, etc.). One of the key
advantages of the paperless processing system is the ability to manage
workload on a national basis, unconstrained by the geographic
limitations of paper claims. The advent of a national workload
assignment system will allow specialization in specific and more
complex claims or disabilities by employing targeted training. The
assignment of more complex claims or disabilities to specialized
stations will free up other stations to focus on high claims-processing
output.
Question 5: AFGE has provided us with training recommendations in
their Statement for the Record. They raise some important points, such
as:
a. How much training is provided to new employees prior to allowing
them to process cases?
Response: New employees go through at least 6 weeks of training
before they process real cases and spend another 4 weeks in a
centralized environment where they work cases under the direction of
nationally recognized instructors. These instructors provide daily
individual mentoring and feedback. VBA tracks the production and
accuracy of each student. At the end of the centralized training,
students return to their home offices where they continue to work cases
under the guidance of local subject matter experts (SME).
b. In addition to the Change Management Agents that have been
placed at each RO, how is employee input and other feedback included to
improve current training or to develop new training programs?
Response: Training Managers from each regional office participate
in monthly calls with the Training Staff of Compensation Service to
provide input and feedback on VBA's training programs. In addition, the
Training Staff has a special e-mail box that all field personnel can
use to submit ideas and feedback. The National Training Curriculum
workgroup, which includes field Training Managers, meets yearly to
ensure that VBA training is consistent and aligned with organizational
goals. VBA also receives feedback during training sessions from field
instructors and SMEs. VBA further develops new training products and
updates current training based on quality review trends, skills
certification testing results, and inter-rater reliability results.
In addition, Quality Review Specialists (QSR) at the regional
offices review cases and compile error trends at the local level. The
quality review information is used to develop training at both the
local and national levels. The QSRs also provide feedback on accuracy,
mentoring, and training to claims processors.
c. How often are live cases used in trainings?
Response: Live cases are used during both Challenge Training and
Station Enrichment Training (SET). The cases are worked under the
instruction and guidance of nationally recognized subject matter
experts. Regional offices (RO) also use live cases during local
training. The cases are reviewed and the results are used to pinpoint
knowledge gaps among claims processors to provide targeted training.
Question 6: AFGE's statement also suggests implementing a time
motion study to better determine appropriate performance standards. Has
VA explored conducting such a study?
Response: VBA conducted a time and motion study at six ROs that was
completed on April 30, 2013. The study focused on identifying time
associated with key claims processing activities and defining labor
requirements for completing specific end products. The results of the
study will be evaluated and used to generate a capacity analysis for
claim processing resource allocation and performance standards
evaluation.
Question 7: AFGE points out that management incentives are largely
based on quantity of production. How are incentives calculated to also
take into account quality of production?
Response: The evaluation of RO Directors is based on performance in
five critical elements, including leading change, leading people,
business acumen, building coalitions, and results driven. Weights are
assigned to each of the five elements when evaluating the full
responsibilities of an RO Director. Each element factors in quality
when evaluating an executive's overall performance.
Question 8: The Committee was informed that the VBA does not have a
unified system for aggregating and analyzing the results of both the
coach reviews and the STAR reviews.
a. What has been done to strengthen the Systematic Technical
Accuracy Review (STAR) program and to create a more unified review
system that ensures proper follow-up, remediation, and training?
Response: VBA has created dedicated Quality Review Teams (QRT) at
all ROs to reach the strategic goal of 98 percent rating accuracy by
2015. All QRTs have received, and will continue to receive, training
conducted by VBA's Quality Assurance Staff to help ensure consistency.
VBA has implemented an internal QRT within the STAR staff that
reviews STAR errors that impact national quality. The STAR QRT conducts
periodic quality reviews to promote consistency of the reviews
performed by the STAR rating and authorization employees. The STAR QRT
also reviews and assesses the results to identify training needs for
the QRTs in ROs.
Question 9: Have there been any updates or improvements to the work
credit system to also focus on accuracy?
Response: In December 2012, VBA revised the performance standards
to shift the evaluation of claim processor quality from claim-based to
contention-based. Evaluating quality at the contention level allows
management to identify employee deficiencies on specific disabilities
and provide focused training. The Automated Standardized Performance
Elements Nationwide (ASPEN) tracker was upgraded to reflect the shift
in performance standards. Enhancements such as drop-down menus will
increase data-entry accuracy and simplify the entry of work credit for
claims processors.
Question 10: In consideration of moving into a new processing
system, when does VBA plan to reconsider the work-credit system?
Response: VBA recognizes the importance of assessing the impact of
our transformation initiatives on job requirements and appropriately
adjusting the work credit system for claims processors. VBA established
a new team in April 2013 to work on shifting employee work credit entry
from ASPEN to VBMS as we move into an electronic environment. The team
will work in concert with VBMS programmers to ensure the requirements
and functionality for individual employee work credit entry is
incorporated into VBMS.
Process Questions
Question 1: Does it make sense for VA, in a paperless processing
system, to have high performing stations specialize and focus on the
difficult claim types?
Response: As previously discussed, one of the key advantages of the
paperless processing system is the ability to manage workload on a
national basis, unconstrained by the geographic limitations of paper
claims. The advent of a national workload assignment system will allow
specialization in specific and more complex claims or disabilities by
employing targeted training. The assignment of more complex claims to
specialized stations will free up other stations to focus on high
claims processing output.
Question 2: Does VBA believe that focusing on a ``claim'' is an
effective way to evaluate their workload? Is there a more accurate way
to estimate the actual workload and to distribute and specialize it?
Response: Claim level productivity does not provide the full
picture of VBA's current workload and the productivity of our
employees. As mentioned at the hearing, today's Veterans are claiming
many more disabilities (between 12 and 16 for recently separating
Servicemembers), resulting in an increase of medical issues rated per
claim and adding to the complexity of the process and the time to
complete the claim. There is no limit on the number of issues an
individual can claim.
Each issue may require VBA to take specific action to obtain
evidence in support of the claim, including Federal records, private
medical records, VA examinations, employment information, and Veterans
Health Administration (VHA) medical records. VBA is currently
implementing transformation initiatives aimed at reducing time to
complete claims and eliminating the claims backlog. One aspect of this
effort is implementing segmented lanes at each RO. The claims are
triaged and assigned to lanes based on the number or complexity of
contentions identified. The new method will allow for claims with fewer
or less complex contentions to be worked by a separate team than those
claims with numerous or more complex contentions.
One of the key advantages of the paperless processing system is the
ability to manage workload on a national basis, unconstrained by the
geographic limitations of paper claims. The advent of a national
workload assignment system will allow specialization in specific and
more complex claims or disabilities by employing targeted training. The
allocation of high complexity claims to specialized stations will free
up other stations to focus on high claims processing output.
Question 3: What proportion of all claims in the past fiscal year
had a medical condition that was paid in advance of the complete
adjudication of the claim?
Response: Intermediate rating decisions were made on approximately
12 percent of claims. It should be noted that roughly 77 percent of
Veterans who have a supplemental (subsequent) claim pending are already
receiving monetary compensation for disability. Supplemental claims
make up 61 percent of the claims inventory.
a. What proportion of claims at the Togus VARO, in the past fiscal
year, had a medical condition that was paid in advance of the complete
adjudication of the claim?
Response: Intermediate rating decisions were made on 13.4 percent
of disability claims. About half of the Veterans with open claims in
VBA's inventory are already receiving some level of compensation from
VA.
b. What proportion of claims at the Los Angeles VARO, in the past
fiscal year, had a medical condition that was paid in advance of the
complete adjudication of the claim?
Response: Intermediate rating decisions were made on 17 percent of
disability claims.
Question 4: What factors inhibit a ``pay as you go'' process in a
paper based adjudication model?
Response: VA is not prohibited from awarding benefits to a claimant
prior to resolving all contentions. The VA claims adjudication manual
(M21-1MR, III.iv.6.A.1.a) requires intermediate rating decisions be
made if the record contains sufficient evidence to grant any
contention(s), including service connection at a non-compensable level.
a. Will all of these concerns be eliminated in a paperless
processing system?
Response: VA is not precluded from awarding a claimant entitlement
to benefits prior to deciding all contentions.
b. How will VBA be better situated to pay medical conditions as
they are completed?
Response: When fully implemented, VA's paperless processing system,
VBMS, will assist claims personnel in finding information faster and
managing workload more efficiently. This will allow VA to more quickly
and consistently award benefits to Veterans.
Question 5: Under the Fully Developed Claims program (FDC) program:
a. How many are new claims vs. an increase in ratings?
Response: FY to date, VA has completed 19,722 FDCs. Of these,
11,278 were original rating claims and 8,444 were supplemental rating
claims, including claims for increased evaluations.
b. Currently, claimants are unable to go use the FDC process if
they have other claims pending adjudication that aren't in the FDC
program. Has VA explored changing this?
Response: Yes. VA designed the FDC program as an optional means for
a claimant to receive a decision faster. If a claimant files a new
claim while another claim is already pending with VA, that new claim,
regardless whether it is fully developed, will often extend the time it
takes to complete processing both claims because VA must often complete
new, unanticipated development actions. These new actions thwart the
promise of expeditious processing of the FDC.
At the request of stakeholders, VA made an exception to this rule
if the pending claim is an appeal and the claims folder is located at
the station of jurisdiction and not at the Board of Veterans' Appeals.
Such a claim would not impact the timely completion of the newly
received claim.
c. What sort of incentives is VA exploring for VSO, State, and
County partners to increase FDC submissions?
Response: VA is currently working with the American Legion,
Disabled American Veterans, to expand and enhance the FDC program. As
part of this initiative, VA is exploring a program that would recognize
outstanding achievements of VA partners, including Veterans Service
Organizations (VSO) and other entities, which demonstrate exemplary
support of the FDC program.
d. Is there any way that VSO's can assist in providing all of the
information required for an instantaneous benefit decision and payment
for certain types of medical conditions or presumptions? For instance,
could a VSO National Service Officer certify that a Vietnam veteran was
in country and had Ischemic Heart-Disease and then subsequently provide
VBMS with the required information for an immediate approval?
Response: As previously mentioned, VA makes intermediate rating
decisions if the record contains sufficient evidence to grant any
contention(s). VA encourages VSOs to assist claimants in providing all
evidence needed to immediately decide a claim or contention.
Question 6: I understand that 71 of 81 individual Disability
Benefits Questionnaires (DBQs) are available to private physicians.
What 10 are still unavailable and why?
Response: Ten of the 81 DBQs are for internal use only and VA does
not plan to make them available to the public because they require C&P
examiners to complete specialized training provided by VHA. The 10 DBQs
are for compensation, pension, Gulf War, specialty exams for cold
injury residuals, former Prisoner of War protocol, initial Post-
traumatic Stress Disorder (PTSD), initial and review of traumatic brain
injury, hearing loss and tinnitus, and the medical opinion DBQ.
Question 7: In testimony at a previous hearing, the American Legion
suggests a place on each DBQ for a doctor to state a critical nexus
opinion, or an assessment of the likelihood any present disability is
related to a veteran's service experience. Has this suggestion been
explored?
Response: Yes, VBA explored the suggestion. VBA considered adding a
question about medical nexus on every DBQ; however, VA examination
request data shows that a medical nexus opinion is generally not
required on a compensation and pension examination. For example, if an
examination pertains to a claim for increased rating, a medical nexus
opinion is not needed because service connection has already been
established. In an overwhelming number of cases, requesting a physician
to dedicate the time and resources to research and opine on the
likelihood of a relationship existing between any present disability
and military service would be unnecessary. Therefore, VBA decided not
to include a specific question on medical nexus on DBQs.
Question 8: Can you provide an update on what has been done to
strengthen the quality review process for DBQs to verify private
physicians, track disability ratings that used DBQs, store completed
DBQs electronically, and other fraud prevention controls?
Response: Current guidance requires a special issue ``flash'' in
the claims file indicating whether a VA or private DBQ was received as
medical evidence to be used when claims processors input claims in the
system. In January 2013, VBA completed validation of 1,276 DBQs
completed by private physicians. VBA concluded that there is little
evidence of increased fraud risk. VBA will continue its quality
assurance reviews on at least a biannual basis to verify the
authenticity of information on DBQs completed by private providers.
VA is developing a long-term strategy for secured electronic
submission of DBQs received outside the VA examination process via an
electronic portal that will enable VA to more easily verify physicians'
identity and credentials. VBA has also revised the DBQ notifications to
Veterans and physicians to inform them that information submitted on
DBQs is subject to verification.
Question 9: Can you provide an update on the revision of the VA
Schedule for Rating Disabilities and timeline for when the review of
the 15 different body systems will be complete?
Response: VBA expects to complete the initial update of the VA
Schedule for Rating Disabilities for all body systems by the end of
2016. The current status of the regulations is below.
Draft regulations for the endocrine and hemotologic/
lymphatic systems are under review by VA's Office of General Counsel.
Draft regulations for the digestive and dental/oral
systems are under review within the Compensation Service.
Draft regulations genitourinary, audiology,
cardiovascular, respiratory and infectious diseases systems are under
peer review.
Draft regulations for ears, nose, and throat, eye
diseases, skin disorders, and neurological/convulsive systems are
currently being written.
Workgroup discussions are under way for gynecological/
breast, musculoskeletal/rheumatology and mental disorders.
Question 10: What challenges do you face in regards to receiving
electronic Service and Personal records from the National Guard or
Reserves for the purposes of adjudicating claims?
a. Does both the Guard and Reserve a central location in which
these records are stored?
Response: VA does have access to military personnel files of
Reserves and National Guard members through the Department of Defense's
(DoD) Defense Personnel Records Information Retrieval System (DPRIS).
DPRIS currently provides personnel files for:
Air Force - October 2004 to the present;
Army - October 1994 to the present;
Navy - 1995 to the present; and
Marine Corps - January 1999 to the present.
However, there is not a central location to obtain service
treatment records (STR) for Reserve and National Guard units. Because
the locations of STRs vary for National Guard and Reserve units, when
VA develops evidence for original disability compensation claims, it
asks Reserve/National Guard Veterans to provide the name, address, and
phone number of their units.
The Army and the Air Force have implemented centralized cells where
Servicemembers can forward STRs when they separate or retire, including
Reserve or National Guard units. The central cells verify whether the
Veteran has a VA claim and forward the STRs to the RO if a claim is
pending. If there is no pending disability claim, the Army or Air Force
central cell forwards the STRs to the Records Management Center (RMC).
Currently the Navy, Marine Corps, and Coast Guard forward all STRs to
the RMC.
b. Does both the Guard and Reserve have a standardized format in
which they complete and store these records?
Response: All of the military branches maintain a single STR for
each Servicemember that contains documents in both electronic and paper
formats. In 2012, DoD and the National Archives and Records
Administration, updated DoD's Standard Form (SF) 115, Request for
Records Disposition Authority. The SF 115 specifies requirements for
systems of medical records, transfer of STRs between DoD and VA, and
disposition of STRs in both paper and electronic formats.
c. What challenges does this present to VA in trying to adjudicate
these men and women's claim in a timely fashion?
Response: The law requires that VA's efforts to obtain Federal
records shall continue until it obtains the records unless it is
reasonably certain that such records do not exist or that further
efforts to obtain those records would be futile.
The challenge that VA faces in obtaining Federal records varies
depending on the location or system in which the record is maintained.
Current procedures require VA to mail a letter directly to the Reserve
unit or the Adjutant General's office to obtain these records.
Additional problems in obtaining STRs occur when Veterans transfer
between units, redeploy, or separate from the military during the claim
processing cycle.
d. Are VA employees receiving specific training on dealing with the
records and attendant problems of Guard and Reserve members?
Response: VA employees receive training on records management prior
to developing disability claims and also receive refresher training
throughout their careers. This training contains instruction on how to
process requests for records from all service departments and each
component, including Reserve, and National Guard.
Question 11: I understand that some of the veterans' service
organizations had issues with Simplified Notice Letters being confusing
and overly generic.
a. Has VA worked with the VSOs to fine tune some of the SNL
language so that they provide sufficient and specific information to
inform veterans about the reasons and basis for rating decisions?
Response: VBA sought input from the VSOs when first developing the
Simplified Notification Letter (SNL). VBA also held several training
and discussion sessions with VSOs during the introduction of the SNL.
VBA continues to provide training to and have discussions with our VSO
partners on the SNL. The VA remains committed to improving the decision
notice for Veterans.
Technology Questions
Question 1: I understand that we are contracting out the work to
scan documents into VBMS, but there are concerns that pages are
sometimes not in order, that pages are missing, or that files contain
pages of information from other veterans.
a. What quality metrics are we holding these contractors up to and
how are the various contractors performing?
Response: Since execution of the contract for the document
conversion services, VBA has employed multiple tools to ensure high
quality. VBA provides document conversion SMEs on-site to provide rapid
feedback to the vendors. In addition, quality control checks are
performed by each contractor as part of their internal process.
VBA recently procured independent validation and verification
(IV&V) services to replace VBA quality assurance checks. This contract
enables VBA to utilize data-driven, statistically valid sampling
methodologies to ensure document conversion standards are met. IV&V
will ensure objective future reporting of quality metrics. The metrics
include image quality (99 percent standard), indexing quality (99
percent standard), and extraction (95 percent standard). If the
document conversion services vendors do not meet the contractually
required quality levels, VBA may refuse to pay them.
Question 2: In regards to latency issues with VBMS, is this due to
data storage in one location?
Response: ``Latency'' is a term that has been misused or used in
multiple contexts. It has been used to describe the time difference
between new and old ways of doing work, between the time difference in
loading files of varying sizes, impacts of Internet connection issues,
and many other descriptions. We believe the question is attempting to
refer to the time it takes for a folder and its contents to load once
clicked. At this time, the document storage location has not been
determined to be a factor in perceived latency for VBMS, because the
network times and download rates are not major contributors to observed
latency. Outside of occasional system issues, which can be expected in
incremental delivery approaches, VBMS is meeting production demands and
not experiencing latency issues.
Question 3: The National Organization of Veterans Advocates points
out that currently, claimants are only able to access their case files
by either requesting a paper copy, which often takes months, or by
visiting the VA Regional Office by appointment.
a. Once VBMS is fully implemented, will veterans have electronic
access to look at their own case files?
Response: When VBMS is fully integrated with online claims
submission functionality through eBenefits and the Stakeholder
Enterprise Portal (SEP), Veterans will be able to view all the
documents in their eFolder.
Question 4: I understand that VSOs have electronic access VBMS.
a. Are the VSOs able to access all files of the veteran they are
working with?
Response: VSOs can access and view records of Veterans who they
represent. If the Veteran does not authorize VA to disclose information
related to treatment for drug abuse, alcoholism or alcohol abuse,
infection with the human immunodeficiency virus, or sickle cell anemia,
the VSO will not be able to view the Veteran's record.
b. Will private attorneys be able to have access down the line?
Response: The plan for the SEP includes providing access to many VA
business partners who serve our Veterans. Private attorney access is
included in the future vision for SEP functionality.
Question 5: Blinded Veterans of America raises the issue that VA
has had internally identified American Disabilities Act (ADA)
Disability Section 508 Compliance issues in the past 18 months and one
of the significant barriers for blinded veterans trying to file or
track their claims electronically is lack of accessibility.
a. What sort of resource planning for addressing ADA 508
Accessibility for FY 2014 is being made now and for FY 2014?
Response: Making VA accessible for all Veterans, beneficiaries, and
employees is important not only because it is the law, but because it
is the right thing to do. Previously, VA's Section 508 information
technology compliance efforts were divided between the ``Section 508
Program Office'' within the Office of Information and Technology (OIT),
and the ``Health 508 Office'' in VHA. In FY14, all 508 efforts will be
centralized within OIT.
In FY14, the combined government information technology staff for
both offices will be 11 FTEE. The FY14 President's Budget has
$37,265,000 identified for ``Product Development (PD) Tools Management
Competency.'' This line item includes funding for PD's ``Product
Assessment Competency Division'' of which $11,871,309 is for VA's 508
program.'' Non-pay funding will cover:
Contracted resources to support the development and
execution of Section 508-related training for developers, testers and
non-technical staff.
Testing support services to: (1) bring new software into
compliance with Section 508 requirements; and (2) audit existing
Section 508-compliant software to ensure that it remains compliant.
Maintenance of hardware and software that is used to test
IT systems for Section 508 compliance.
Development of an enterprise-wide approach to bring all
VA SharePoint repositories into compliance with Section 508
requirements.
b. What is the time frame for fixing eBenefits Program to meet ADA
508 Access?
Response: VA expects to have the eBenefits portal conformant with
ADA 508 access requirements within the next 6 months.
Implementation Questions
Question 1: What is being done to prepare for the estimated 774,000
claims (from FY 2013 to FY 2015) that are anticipated as a result of
the Veterans Opportunity to Work Act/Veterans Employment Initiative and
the Camp Lejeune legislation?
Response: VBA's transformation is designed to improve benefits
delivery by better leveraging employee skills and streamlining the
claims adjudication. In the face of dramatically increasing workloads,
VBA is vigorously pursuing its Transformation Plan that includes a
series of tightly integrated people, process, and technology
initiatives designed to increase Veterans' access, eliminate the claims
backlog, and achieve our goal of processing all claims within 125 days
with 98 percent accuracy in 2015.
Over the last 24 months, VA has implemented several ``process''
initiatives such as DBQs, SNLs, evaluation builders and rules-based
calculators, and the FDC initiative. In addition, VA established local
QRTs to provide timely, responsive quality assurance and training to
its workforce. VBMS, VBA's tool for paperless claims processing, will
provide functionality to allow specialization by RO, team, and
employee. Functionality built into VBMS provides flexibility to allow
us to better manage our workload as we move into the fully paperless
environment. VBA continues to work with partners and stakeholders to
identify requirements for the full functionality of VBMS. VBA estimates
that once VBMS is fully developed, integrated, and implemented it will
help improve our production performance by at least 20 percent (in each
of FYs 2014 and 2015) and quality by at least 8 percent.
The Louisville RO is our centralized site for the processing of
Camp Lejeune claims. The RO has averaged 246 claims per month since the
enactment of the Honoring America's Veterans and Caring for Camp
Lejeune Families Act of 2012. The Louisville RO is poised to alert any
significant increase in these claims. Any change in the volume of
claims will be addressed and an increase in capacity to handle any
surge will be made. Should a surge occur, VBA is prepared to leverage
the use of its transformation initiatives to manage this workload.
Question 2: What sort of outreach and public education is being
conducted to educate veterans on all of these new initiatives?
Response: VBA uses several avenues to communicate with and educate
Veterans, Servicemembers, families, and other stakeholders on the new
initiatives. These include Facebook Office Hours, Twitter Town Halls,
and VA YouTube videos. VBA has also redesigned many external facing Web
pages to provide current information on the initiatives and how to
access benefits. Through our partnerships with VSOs and Non-Profit
organizations, we are able to push out information through their
communication vehicles including publications and Web sites. In
addition, VBA partners with DoD to expand and improve information
sharing, refine processes of records retrieval, and identify procedures
to improve benefits process. Specific to outreach, this data sharing
has allowed for the deployment of early communication messages to
Servicemembers informing them of eligibility for benefits based on life
and career event triggers.
Question 3: Can VBA please compare the performance of the paper
based model versus the new transformation model at stations that have
been in VBMS and the Transformation Organization Model since January?
In particular, can VBA clearly identify and articulate increases in
efficiency and the accuracy of claims processing.
Response: Productivity is measured by Rating Veterans Service
Representatives (RVSR) individually and by combined Veterans Service
Representatives (VSR) and Claims Assistants (CA). The percent change in
productivity is measured by monthly averages for the most recent end of
month data compared to the same period of the previous year.
Analysis of productivity for all stations in the organizational
model and VBMS for end of month February 2013, compared to the same
month in 2012, indicates improvement in productivity per RVSR by 15.3
percent and 0.5 percent for VSRs and CAs. The data includes the whole
of transformation and the 40 plus transformation initiatives which are
designed to improve production by 45-60 percent and quality by 14
points in calendar year 2015 as an integrated business transformation
model. It is difficult to extract each initiative from the combined
people, process, and technology model to provide detail-level analysis
toward the contribution to productivity outcomes.
VBA began deployment of VBMS Generation One in September of 2012,
concluding the year with a total of 18 stations on the system. It is
important to note that early adopters of first generation technology
participated heavily in the development and refinement of efficiencies
and functionality of the system, which had a direct impact on
productivity as a result of the live test environment. These stations
paved the way for the accelerated deployment of VBMS which will enable
VBA to track and measure productivity outcomes in a consistent and
accurate manner, once all stations are operating with the new
technology and after a period of stabilization. The first 18 stations
enabled VBA to also test business processes and functionality for the
establishment of eFolders in VBMS and the model for tracking and
shipping of paper-based claims with two scanning vendors.
Questions from Rep. Dina Titus
Question 1: General Hickey, Reno is taking 478 days on average to
complete a claim. While it sounds like VA is working hard to move
towards an electronic system the numbers continue to head in the wrong
direction.
a. Do you have any information that you can share with the
committee regarding the transformation that indicates that your team is
heading in the right direction?
Response: The Reno RO is focusing all available resources on
working claims in the backlog. In addition, the RO is actively engaged
in implementing VBA's people, process, and technology transformation
initiatives. In November 2012, the RO implemented the Transformation
Organizational Model, in which claims are processed through segmented
lanes based on their complexity and need for case management. The RO
implemented VBMS, VBA's paperless processing tool, in April 2013. The
office continues to work closely with the VSOs to increase the number
of FDCs submitted to enhance RO performance. Monthly meetings are held
with all VSOs on the FDC process. The increase in FDCs reduces
development time and resources needed for claims development
b. When can we expect the Reno VA Regional Office to begin reducing
their average time?
Response: The Reno RO is actively engaged in increasing production
and focusing on their oldest claims. As the RO works its oldest claims,
the average days to complete will continue to increase. However, once
these oldest claims are completed, the average processing time will
decline. We anticipate significant improvements in processing time
beginning in FY 2014.
Question 2: General, can you please explain to me how you have
determined that a VA Regional Office should receive the station
enhancement training and have you considered Reno?
Response: In March 2012, VBA initiated SET, focused on improving
the performance of low performing ROs. In deciding whether to provide
SET, VBA considers such factors as production, accuracy, feedback from
Congressional stakeholders, and input from oversight groups such as the
Office of the Inspector General or General Accountability Office. The
Baltimore RO is currently receiving SET, which began on April 8 and
concluded on May 2, 2013. VBA is working to finalize the schedule and
locations of SET to be held in the remainder of FY 2013 and FY 2014.
VBA will consider your request to provide SET to the Reno RO.
Question 3: General Hickey as I am sure you know over 240,000 of
the claims in your inventory is stuck in a holding pattern known as
awaiting evidence. 25% of those claims have been awaiting DoD personnel
records for more than 60 days and 13% have been waiting for more than
90 days. In addition, Service Treatment Records take on average 55 days
to be received. This is a long time for VA to be waiting for
information from DoD and leads to delays for our Veterans.
Response: VBA continues to regularly and diligently work with DoD
to obtain complete STRs faster and more efficiently.
Question 4: Now, in your testimony before the Senate you indicated
that VA and DoD had reached an agreement that DoD would provide you
with certified to be complete medical and personal records. You also
indicated that this would not reach full operational capability until
2017, can you further elaborate on this timeline and what was agreed
to?
Response: Effective January 1, 2013, all military services began
complying with the Department of Defense Instruction (DoDI) 6040.45,
Service Treatment Record (STR) and Non-Service Treatment Record (NSTR)
Life Cycle Management, dated October 28, 2010, and the December 06,
2012, agreement with revised language for the certification of STRs.
a. What would occur if DoD does not honor this agreement? What
impact would that have on the backlog in your opinion?
Response: All military services are honoring the agreement to
certify the completeness of the STRs. DoDI 6040.45 mandates that
personnel at military treatment facilities (MTF) certify they have made
all attempts to ensure the STRs are complete and include certain forms.
MTF personnel must transfer the complete STR to their respective out-
processing center no later than 30 business days after the member's
retirement, discharge, or end of active obligated service. If MTF
personnel discover additional documents later, the records are
immediately transferred VA. VA and DoD continue to collaborate to
ensure that the military services continue to comply.
b. Do you have any other concerns in regards to receiving
information from other Federal agencies?
Response: VBA generally receives STRs from DoD faster than records
from the, Defense Finance and Accounting Service, Public Health Service
(Department of Health and Human Services), and National Oceanic and
Atmospheric Administration (Department of Commerce).
Question 5: In a previous Subcommittee hearing last Congress, we
examined how veterans who suffer from Military Sexual Trauma (MST)-
related PTSD have only a 1 in 3 chance of having their claims approved.
a. I understand that VA policy requires that Veterans who have MST-
related PTSD be informed that they may use information from sources
other than their service records to establish credible evidence of the
stressors from MST they have endured before VA can deny their claim. In
your observation of MST cases, is this being done?
Response: Yes. The law requires VA to advise claimants who submit
PTSD claims based on military sexual trauma (MST) that evidence from
sources other than their service records may constitute credible
supporting evidence of the stressor to substantiate the claim.
Accordingly, VA routinely sends a special notice to Veterans filing MST
claims explaining the other types of evidence that may constitute
credible supporting evidence of the MST stressor (such as records from
sources other than the military or evidence of behavior changes). VA
advises Veterans to submit any such evidence in their possession or
identify the location of such evidence so that VA can attempt to obtain
it on their behalf.
b. Has VA looked at creating a separate lane for MST claims?
Response: VBA reorganized its workforce into cross-functional teams
that work together on one of three segmented lanes: express, special
operations, or core. Claims that predictably can take less time to
process (about 30 percent of claims) flow through an express lane);
those taking more time or requiring special handling (about 10 percent
of claims) flow through a special operations lane; and the rest of the
claims (60 percent) flow through the core lane. VBA now processes MST
claims in the special operations lane to ensure the most experienced
and skilled employees manage these complex claims.
c. What more do you think VA can do to improve training of its
employees who adjudicate MST claims so prevent improper denial for lack
of evidentiary documentation?
Response: VBA provided mandatory comprehensive training for
evaluating MST cases in 2012. VBA is also developing robust training to
assist adjudicators in determining the effective date of MST awards
under such reviews.
In addition, recent efforts by VBA have dramatically improved VA's
overall sensitivity to MST-related PTSD claims and have led to higher
current grant rates. However, we recognized that some Veterans' MST-
related claims were decided before these efforts began. To assist those
Veterans and provide them with the same evidentiary considerations as
Veterans who file claims today, VBA is planning to notify Veterans of
the opportunity to request that VA review their previously denied PTSD
claims based on MST. Those Veterans who respond will receive review of
their claims based on VA's heightened sensitivity to MST and a more
complete awareness of evidence development. VBA will also continue to
work with VHA medical professionals to ensure they are aware of their
critical role in processing these claims.
Question 6: Can VBA please provide a detailed roadmap of how it
expects to reach its goal of no veteran's claim pending longer than 125
days with 98% accuracy by 2015. This should include a detailed analysis
of each of the 56 VA regional offices with the productivity and
benchmarks they expect from each of these offices to reach the goal and
reduce the backlog.
Response: VBA established the VBA Operations Center within the
Office of Field Operations in 2013 to focus on accountability to
achieve workload performance metrics and sharing of best practices
across VBA ROs and VBA leadership.
The VBA Operations Center oversees VBA's monthly Stat Review
program, which is a critical performance technique and tool VBA has
employed using statistical data (Stat) and visual displays of that data
to improve performance of ROs and monitor transformation progress. This
process involves in-depth performance metric reviews of each RO
designed to analyze and manage performance more effectively. VBA's Stat
Review is based on the highly successful New York City Police
Department's CompStat performance management program.
As a monthly event, the Stat Review identifies patterns occurring
at various ROs, and every RO participates either in person or by
teleconference. This program is an effective leadership tool to guide
efforts to reach the Secretary's goal of processing disability claims
in 125 days with 98 percent accuracy.
During the Stat Reviews, VBA top leaders discuss RO challenges and
successes in day-long meetings, using extensive data-driven performance
measures for accountability. This allows VBA to identify improvements
that are needed to produce desired performance results. These Stat
Reviews help VBA more clearly understand what actions are being taken
to improve performance, what is or is not working, while motivating RO
managers and employees to focus their energy and creativity on
achieving specific results. These reviews help to ensure that best
practices and lessons learned are shared quickly across leadership
teams and that we have alignment across ROs on transformation.
VA's ``ASPIRE'' Web site provides detailed monthly performance
dashboards that include claims processing targets for each regional
office and tracks performance against those targets. http://
www.vba.va.gov/reports/aspiremap.asp
VBA is aggressively pursuing its Transformation Plan, a series of
tightly integrated people, process, and technology initiatives designed
to eliminate the claims backlog, and achieve the goal of processing all
claims within 125 days and with 98% accuracy in 2015. VBA is
retraining, reorganizing, streamlining business processes, and building
and implementing technology solutions based on newly redesigned
processes in order to improve benefits delivery. As part of our
transformation we have done the following:
Developed and implemented a new claims processing model -
one that better leverages employee skills, and streamlines claims
adjudication. All 56 ROs are operating under this model as of the week
of March 25.
Developed, tested, and deployed requisite software and
hardware to process disability claims paperlessly. From submission/
receipt/scanning to display/review/decision, we now have the capability
to complete a claim without touching paper. As of May 10, 46 ROs and
our Appeals Management Center have fielded this capability, called
VBMS. The remaining ROs will field VBMS by the end of this year. As of
April 28, over 82,000,000 individual pieces of paper from Veterans'
records have been converted to images, and over 15 percent of our
claims inventory is now in VBMS. Clearly, information technology plays
a critical role in eliminating the claims backlog, and the Department's
information technology budget has and will enable VA to develop and
deploy these important tools.
Designed and implemented new training programs to prepare
employees for the changes being implemented. The entire VBA claims
processing workforce was trained on the new processing model, and over
half the workforce has been trained on VBMS. The 2,431 employees who
have received the new Challenge training decide 150 percent more claims
per day than predecessor cohorts, at a similar stage in their
development, with a 30-percent increase in accuracy.
Designed and implemented the Veterans Relationship
Management (VRM) initiative to expand and improve access to VA benefits
and services. Capabilities and programs integrated within VRM include
eBenefits (an online portal for Veterans and Servicemembers with self-
service capabilities); SEP (for external partners such as VSOs);
Customer Relationship Management (to improve service in our contact
call centers); myHealtheVet (for enrollment in health benefits); Blue
Button (for access to individual medical records), and Veterans On-Line
Application Direct Connect (for electronic claims submission).
Implemented the QRT and the SNL initiative nationwide.
VBA tracks the impact of these initiatives on accuracy through a 3-
month rolling average accuracy metric that is reported in ASPIRE
(http://www.vba.va.gov/reports/aspiremap.asp) and can be seen online by
the public. FY 2012 data demonstrated a 3-percent increase in national
accuracy standards - from 83 percent to 86 percent. The accuracy
further increased to 89 percent when looking at just the last 3 months
of accuracy reviews.
Completed over 1,000,000 million claims per year in FYs
2010, 2011, and 2012, the 3 highest production years in VBA history.
This included 260,000 claims resulting from the decisions to add 3 new
presumptive conditions for Veterans exposed to Agent Orange. VA's
regulation changes that made it easier for Veterans to establish PTSD
as a service-connected disability and created presumptions for nine
diseases related to service in the Gulf War also contributed to this
growth in claims receipts.
Added more than 940,000 Veterans to its compensation
rolls over the past 4 years, which is more than the size of our active
duty Army and Navy combined.