[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
VA'S DEVELOPMENT AND IMPLEMENTATION OF POLICY INITIATIVES
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
THURSDAY, NOVEMBER 29, 2018
__________
Serial No. 115-83
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
___________
U.S. GOVERNMENT PUBLISHING OFFICE
35-948 WASHINGTON : 2019
COMMITTEE ON VETERANS' AFFAIRS
DAVID P. ROE, Tennessee, Chairman
GUS M. BILIRAKIS, Florida, Vice- TIM WALZ, Minnesota, Ranking
Chairman Member
MIKE COFFMAN, Colorado MARK TAKANO, California
BILL FLORES, Texas JULIA BROWNLEY, California
AMATA COLEMAN RADEWAGEN, American ANN M. KUSTER, New Hampshire
Samoa BETO O'ROURKE, Texas
MIKE BOST, Illinois KATHLEEN RICE, New York
BRUCE POLIQUIN, Maine J. LUIS CORREA, California
NEAL DUNN, Florida CONOR LAMB, Pennsylvania
JODEY ARRINGTON, Texas ELIZABETH ESTY, Connecticut
CLAY HIGGINS, Louisiana SCOTT PETERS, California
JACK BERGMAN, Michigan
JIM BANKS, Indiana
JENNIFFER GONZALEZ-COLON, Puerto
Rico
BRIAN MAST, Florida
Jon Towers, Staff Director
Ray Kelley, Democratic Staff Director
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
MIKE BOST, Illinois, Chairman
MIKE COFFMAN, Colorado ELIZABETH ESTY, Connecticut,
AMATA RADEWAGEN, America Samoa Ranking Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
JIM BANKS, Indiana CONOR LAMB, Pennsylvania
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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Thursday, November 29, 2018
Page
VA's Development And Implementation Of Policy Initiatives........ 1
OPENING STATEMENTS
Honorable Mike Bost, Chairman.................................... 1
Honorable Elizabeth Esty, Ranking Member......................... 4
WITNESSES
Honorable Paul R. Lawrence, Under Secretary for Benefits,
Veterans Benefits Administration, U. S. Department of Veterans
Affairs........................................................ 6
Prepared Statement........................................... 37
Accompanied by:
Mr. Willie C. Clark, Sr., Deputy Under Secretary for Field
Operations, Veterans Benefits Administration, U. S.
Department of Veterans Affairs
Ms. Beth Murphy, Director, Compensation Service, Veterans
Benefits Administration, U. S. Department of Veterans
Affairs
Honorable Michael J. Missal, Inspector General, Office of
Inspector General, U. S. Department of Veterans Affairs........ 8
Prepared Statement........................................... 39
Mr. Michael S. Figlioli, Deputy Director, National Veterans
Service, Veterans of Foreign Wars.............................. 26
Prepared Statement........................................... 44
Mr. Shane L. Liermann, Assistant National Legislative Director,
National Legislative Service, Disabled American Veterans....... 28
Prepared Statement........................................... 47
Mr. Greg Nembhard, Deputy Director, Veterans Affairs and
Rehabilitation Division, The American Legion................... 30
Prepared Statement........................................... 53
STATEMENT FOR THE RECORD
Letter From: Thomas S. Kahn, Director, Legislative Affairs,
American Federation of Government Employees, AFL-CIO (AFGE).... 56
VA'S DEVELOPMENT AND IMPLEMENTATION OF POLICY INITIATIVES
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Thursday, November 29, 2018
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Disability Assistance
and Memorial Affairs,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 10:30 a.m., in
Room 334, Cannon House Office Building, Hon. Mike Bost
[Chairman of the Subcommittee] presiding.
Present: Representatives Bost, Coffman, Radewagen, Bergman,
Banks, Esty, Lamb.
Also Present: Representatives Roe and Peters.
OPENING STATEMENT OF MIKE BOST, CHAIRMAN
Mr. Bost. Good morning. The oversight hearing of the
Subcommittee on Disability Assistance and Memorial Affairs will
now come to order.
I would like to welcome the Under Secretary of Benefits,
Paul Lawrence. Since this is your first appearance before this
Subcommittee, before we begin this hearing, I would also like
to yield to the Full Committee Chairman, Phil Roe. I understand
that Chairman Roe would like a few moments to clarify something
discussed during the Economic Opportunity hearing a couple
weeks ago.
And with that, Chairman Roe.
Mr. Roe. Thank you, Mr. Chairman.
I want to thank Chairman Bost for giving me just a few
minutes of the hearing time today to ask a question regarding a
topic that has been prominent in the news and is of the utmost
importance to our student veterans.
Dr. Lawrence, thank you for being here to testify today. I
understand that the question I am about to ask is not on
today's topic, but I feel like it is very important that we
clarify these things.
Yesterday, Secretary Wilkie released a statement on his
plan to address GI Bill payment and system rollout delays. And
that statement said in part, quote, ``During this time, VBA
will pay monthly housing allowance rates for the Post-9/11 GI
Bill at the current academic year uncapped Department of
Defense Basic Housing Allowance Rates. The VBA will also
correct retroactively any underpayments resulting from Section
107 and 501 implementation problems,'' end quotes.
On November 15, you and Director of Education Services, Mr.
Worley, testified before this Committee regarding GI Bill
payment and system delays. At that hearing, Mr. Worley stated,
quote, ``We will not go back and try to recover the
overpayments once the IT fix is in. And where we have underpaid
our beneficiary, we will make them whole at the time the IT fix
goes in,'' end quote.
My staff received information yesterday which appears to be
in apparent conflict with what previously and publicly was
stated.
So my question, Dr. Lawrence, is this: Will the new
effective date of Section 107(b) when the system is ready or
will you go back, and as you and Mr. Worley promised a few
weeks ago, ensure that all students be made whole who are
underpaid since the August 1, 2018, deadline stated in the law?
Mr. Lawrence. Thank you. Let me clarify. We are going to go
back, and for the fall of 2018, recompute the payments using
the 2018 rates, as you indicated, and we will make those people
whole.
Mr. Roe. Okay.
Mr. Lawrence. So overpayments, if there are any, will be
disregarded. Underpayments will be adjusted, and those veterans
will get a check in January.
When the new law goes into effect in the spring of 2020, we
will use the new rates going forward.
Mr. Roe. So basically, the students are going to be held
harmless either way?
Mr. Lawrence. That is correct.
Mr. Roe. The question I have, and I won't take too much
more of the Committee's time, but we have got to have a whole
new system. I think, as I understand it, that system that we
have got currently is not going to be used and it is going to
be rebid. Is that correct?
Mr. Lawrence. Certainly, you are right. So the announcement
yesterday reflected our fundamental thinking about what the
options are going forward, that we need to really address all
the learning we have had and do something different. That is
correct.
Mr. Roe. And I agree with that. And is that going to create
a problem on the lookback? Because we are going to have
hundreds of thousands of these to go through within a year.
Because I think what I had heard, by the end of next year,
December 2019, would be when it would be fully operational. I
think that is the date certain that we were given.
Mr. Lawrence. That is correct. For the spring of 2020, we
will be ready in December of 2019.
Mr. Roe. Okay. Thank you. I yield back.
Mr. Bost. Thank you, Chairman Roe.
Okay. So we are going to move back to our planned hearing.
Today, we are going to focus on how the VA develops and
carries out new policies and procedures.
Most of you know that I ran a family trucking business for
more than 10 years. I know that in order to make successful
changes to our company, you have to sit down and create a plan
to carry out the changes. For instance, you have to decide
whether employees will be needed and need new training or if we
are going to have to update computer software. You also have to
think about how many modifications would impact the rest of the
business, especially whether there will be unintended
consequences that will cause problems down the line. Finally,
you have to design and execute the implementation plan and
figure out whether the changes are working as well as you had
hoped.
Unfortunately, according to the IG, it looks like the VA
does not take these commonsense steps when it develops new
programs. In the last few months, the IG has released at least
three reports that document the problems that arose when the VA
implemented new policies or initiatives.
The VA had these problems because it doesn't appear that
the VBA took the time to consider what they needed to do
successfully and put the new procedures into place, such as
adequately updating the IT systems or training employees prior
to implementation. It also looks like the VA wasn't taking the
time to evaluate whether they were working as intended. In one
report, the IG discovered that when NWQ went into effect,
claims based on military sexual trauma, or MST, were assigned
to any employee even if that employee did not have specific MST
training. In this case, the IG estimates that about 1,300 or
almost 50 percent of the MST claims were not properly developed
before VA issued a denial.
Although I am troubled by these cases, they may not have
been decided properly. We have to remember that this does not
necessarily mean that all of these cases were improperly
denied, but it does mean that the VA did not and didn't follow
all of the safeguards to ensure that this particular sensitive
issue and these particular sensitive cases were handled in the
way they should have been.
I think I can safely speak for all of my colleagues when I
say the claims involving military sexual trauma are some of the
most sensitive that the Department handles. These veterans have
gone through an unimaginable ordeal, and VA owes it to them to
ensure that the cases involving an alleged MST are processed
correctly.
Dr. Lawrence, I look forward to hearing from you about the
VBA and what it intends to move forward based on this report.
The IG also reviewed how the VA handles claims that include
an Intent to File form. The VA developed the Intent to File
initiative to allow veterans to preserve an early effective
date even if they don't have enough information to file the
formal claim. However, the VA didn't think to update VBMS to
flag when the veterans submit an Intent to File form. As a
result, the IG estimates that as many as 23,000 veterans may
have gotten the wrong effective date on their claim. Even
worse, these IG reports expose another major issue within VBA:
poor quality control.
If the IG had not reviewed these three programs, I don't
know how the VBA would have ever identified the problem and
taken corrective action.
I wish I could say these were isolated incidents that we
haven't seen before. I think one reason so many VA's new
initiatives fail or cause serious problems is because VA is so
anxious to find a silver bullet that painlessly solves all the
problems. But the VBA repeatedly rolls out new initiatives
before fully testing them or considering the downstream impact
the changes will have on or how it will affect the VA and how
they can better serve the veteran.
I was encouraged that the Under Secretary for Benefits,
Paul Lawrence, met with me and my staff, and he shared with us
that he recognizes the VBA has to refocus on improving services
for veterans rather than making employees' jobs easier. I also
appreciate the fact the Under Secretary's commitment to
reassessing how the VBA does business so that there is more
care and consideration to how the VBA rolls out new programs,
instead of rushing to get out a product that may not be ready
to go live. That is a step in the right direction.
I look forward to the hearing and hearing from the
Secretary on how he intends to change the VA's culture and
adopt good management practices. We all want the same thing: to
ensure that the veterans receive the benefits they have earned.
Now, I am going to turn over to our distinguished Ranking
Member, Ms. Esty, for her opening statement.
OPENING STATEMENT OF ELIZABETH ESTY, RANKING MEMBER
Ms. Esty. Thank you, Mr. Chairman, for scheduling today's
hearing on three reports issued in recent months by the Office
of the Inspector General at the Department of Veterans Affairs.
And you will see a great deal of consistency between the
Chairman's remarks and mine. And I think you have come to know
that this Committee works in a very bipartisan way, and we all
share the same mission but share some of the same concerns
about what we see happening.
Each one of these IG reports raises serious questions about
inadequate processing of veterans' disability compensation
claims by the Veterans Benefits Administration.
I want to start by thanking Dr. Lawrence and his team for
being here today to respond to these findings, to describe what
you are doing in response to those and, again, for meeting with
the Chairman and with me at length prior to today's hearing.
Though this hearing is setting on the reports on military
sexual trauma, processing inaccuracy and unnecessary medical
exams, there is and additional IG report on the processing of
ALS claims that points to similar issues. And I want to make a
brief aside. It looks like we have reached some accommodation
on ALS, and I hope you will have a chance to describe that,
which I think is indicative of what is encouraging to me about
the attitude you are bringing to changing culture and going
that extra mile.
I am grateful to the VSO representatives in all parts of
the country who raised the alert on some of these issues and
who must play a direct role in the development and
implementation of remedial policy initiatives and procedures
recommended by the IG and with which VA has concurred.
Let me be clear. When the report on military sexual trauma
came to my attention in August, I was disappointed and
disturbed. I had expected that after VBA provided liberalized
guidance in 2011 and VBA's concurrence in the recommendation of
the GAO report in 2014, that veterans who filed disability
compensation claims for PTSD as a result of military sexual
trauma would be finding an easier path establishing service-
connection required for accurate compensation ratings and that
access to VA mental health care and treatment programs that are
so important to recovery. But for too many, this is apparently
still not the case. The IG has reported that 50 percent of
denied claims that they examined from 2017 involved processing
errors.
I know that Dr. Lawrence as well was taken aback with the
report when it was issued, because he immediately put into
place a plan of action, including reviewing 2 years of claims.
But to be blunt, however, there are patterns in all of the
reports that need to concern all of us, this Committee and you
as well.
I see a pattern of not sharing and disseminating best
practices as an ongoing basis and update when VBA is getting
reports back that needs to be part of a continuous improvement,
as Chairman Bost talked about, as we can learn from the private
sector. With the National Work Queue in place, this should
facilitate that, but there needs to be a mission to disseminate
those best practices when we learn them.
That will help address continuing inconsistencies in
regional offices that just with the National Work Queue, we
shouldn't be seeing that kind of variability that we are
seeing. It is of particular concern on the military sexual
trauma claims, and I look forward to hearing your responses on
that.
As the Chairman has noted at length, a real concern with
inadequate planning. You are very responsive, but you need to
take time to step back and figure out how best to implement.
There are several instances in the report where it is clear
that there were secondary impacts that were not properly
assessed or at least not communicated back to us. If more time
was needed or resources, we need to be informed of that. It is
not enough to respond to an IG report and tick the box, because
that is not necessarily achieving the mission. And this really
is my overall point.
The mission is to serve our veterans. And it is a customer
service endeavor. And so that requires going that extra mile.
The IG report sometimes takes several years to produce.
We know in the case of, say, military sexual trauma, the
training materials that we have now are way better than they
were 2 years ago. There needs to be constant updating of that
training. There needs to be dissemination of best practices.
So if the IG puts forward a plan of action, you actually
need to be pushing back to say, we want to achieve the mission,
but if there is a better way to do it, we are going to do it
that way, and not just taking the training materials that are
noted, say, the IG says, you know, best practices from 2013.
Well, that is not good enough in 2018.
And so that is a broader issue. That is a broader issue of
owning the continuous improvement, the mission of serving our
veterans and being proactive in that, as opposed to reactive to
this Committee, the Senate, or the IG reports.
I know everybody here sees themselves as being on Team
Veteran, Team America, but we have to deal with the culture
issues that have led to the series of IG reports, series of
concerns that the mark is being missed. And that is not good
enough for our veterans. It is discouraging and frustrating to
the taxpayers, and we need to do collectively better. But that
is going to require you to be proactive in letting us know and
looking for ways to do that.
I know it is important to recognize we have a number of
people here today for whom the GI Bill revelations are going to
be important. But, again, the purpose of this hearing is, in
particular, to focus on these IG reports that we have had over
the last couple of months.
With that, I want to thank Dr. Lawrence, Ms. Murphy, Mr.
Clark, and the IG, Mr. Missal, for being with us here today,
and we look forward to your presentations.
Mr. Bost. Thank you, Ms. Esty.
I want to welcome the witnesses who have joined us this
morning, and thank you for taking time out of your day and
being here today.
Our first witness is the Honorable Paul R. Lawrence, who is
Under Secretary for Benefits for VA. He is accompanied by Mr.
Willie C. Clark, Sr., VBA's Deputy Under Secretary for Field
Operations, and Ms. Beth Murphy, the Director of Compensation
Services for VBA.
Also joining us at the table is the Honorable Michael J.
Missal, who is the Inspector General for the VA's OIG.
Welcome to all of you.
I want to remind the witnesses that your complete written
statement will be entered into the hearing record.
Dr. Lawrence, you are now recognized for 5 minutes.
STATEMENT OF PAUL R. LAWRENCE
Mr. Lawrence. Good morning, Chairman Bost, Ranking Member
Esty, and Members of the Subcommittee. We appreciate the
opportunity to speak on the topic of VBA's development and
implementation of policy initiatives. But before I get into my
opening statement on the subject of this morning's hearing, I
want to address a misleading NBC news story from late yesterday
that gives the false impression that some veterans on the GI
Bill will not be made whole with respect to their housing
payments based on the announcement VA made yesterday.
Nothing could be further from the truth. Each and every
veteran on the Post-9/11 GI Bill will be made 100 percent
whole, retroactively if need be, for their housing benefits for
this academic year based on the current uncapped DoD rates. And
beginning in spring 2020, we will be in a position to provide
veterans with the new rates, where applicable, to meet the law
known as the Forever GI Bill.
Once again, each and every, and I mean every single
veteran, will be made whole for their housing benefits this
year. As announced yesterday, the rates we are providing for
the current year uncapped DoD basic rate for housing allowance
based on the location of the schools' main campus rather than
the physical location of the student.
For many students, the DoD BAH rate will be equal to or
higher than their current payment. If a student was overpaid
due to the changes in law or because of VBA's challenges in
implementing the law, the student will not be held liable for
the debt. And starting in spring term of 2020, VA will have
solved its current technology challenges so the Department is
in a position to provide Post-9/11 GI Bill veterans the new
rates, where applicable, to comply with the Forever GI Bill.
Let's move to the topics at hand.
We recognize the significant role that oversight plays in
the importance of the Veterans Service Organizations. We have
worked hard to foster our relationship with the Office of the
Inspector General, the General Accountability Office, and with
congressional members and staffers. We meet monthly with the
OIG to discuss trends and review findings. We have also
recurring meetings with GAO. Since June, we have held monthly
meetings with VSOs to discuss improvement plans to address
issues that affect veterans.
Working with these partners ensures together that the right
elements as we move forward in developing and assessing our
plans for implementation. We appreciate the special
relationship VBA has with the OIG. The invaluable feedback and
observations the OIG provides to VBA leadership enhance our
ability to review our effectiveness and validate our plans. We
count on this continued collaborative relationship and the
feedback that is received. We concur with all the findings in
recent reports and are executing these recommendations.
Let me begin with the report on military sexual trauma. VBA
is committed to serving our Nation's veterans by processing
claims to MST in an accurate and caring manner. By October 2,
2018, VBA provided updated training and guidance to claims
processors. Additionally, VBA developed an action plan that
puts us on track to conduct special focus reviews and
consistency studies in a timely manner. Therefore, we are
returning to the best practices that previously made us
effective, which includes a designation of specialized claims
processors to work these sensitive cases.
Let me turn to the Intent to File. VBA appreciates the
acknowledgment by the OIG that the error rate dropped steadily
to 4 percent during the course of its review. The report also
noted that after March 24, 2015, VA could no longer grant
entitlements to benefits using an informal claim, and a new
form was required. The report highlighted issues identified
with this new form. It also noted that the form was introduced
for quick rollout and insufficient training. We have done
better with our ITF claims and we were able to fix issues while
this report was in motion.
Let me turn to the report on reexaminations. While veterans
are service-connected for a disability that is likely to
improve, VBA establishes a plan to review the current severity
of the condition. Many of these reviews result in
reexamination.
OIG's key findings included reducing the number of
unnecessary reexaminations. In response to this recommendation,
VBA has provided targeted training to identify where
reexamination is needed. We have also created tracking systems
which allow us to better identify and manage the workload. VBA
has also developed a phased implementation plan to assess
quality. Each of the phases focuses on a set of business rules
that help us identify unnecessary case reviews.
Finally, I will address the most recent report on claims
for ALS. VBA concurred with OIG's findings and has taken steps
to address the recommendations to improve the proficiency of
our staff. On November 19, 2018, VBA issued guidance and
updated training to specialized claims processors assigned to
work these complex claims.
Mr. Chairman, we have heard the concerns that VBA has
rolled out many programs too quickly and with insufficient
training. Previously, in an effort to address problems, we
focused on unilateral decisions that did not engage our
stakeholders early enough.
Since I arrived, we have been more thoughtful and
systematic in our approach. I developed three priorities, the
third of which is fostering a culture of collaboration.
One example of the difference in management style is my
first senior leadership conference where meaningful discussions
led to the development of 14 integrated groups with both
headquarter and field membership. These groups gather data,
conduct analysis, collaborate with stakeholders, and map out
plans for solutions on topics ranging from performance
management to quality improvements to reducing rework.
I launched several organizational assessments, including
utilizing external consultants to survey several functions and
offices in VBA to obtain objective insights, appraisals and
recommendations for improvement based on best practices.
I am implementing a deliberative approach to planning,
consulting, executing, assessing, and then doing course
corrections and leveraging best practices with each new
initiative or policy change. VBA is now focused on continuous
improvement, and we do this deliberatively and collaboratively.
We look forward to coming back to you as a group or
individually to discuss our successes.
This concludes my testimony. I look forward to answering
your questions.
[The prepared statement of Paul Lawrence appears in the
Appendix]
Mr. Bost. Thank you, Mr. Lawrence.
Mr. Missal, you are recognized for 5 minutes.
STATEMENT OF MICHAEL J. MISSAL
Mr. Missal. Thank you.
Chairman Bost, Ranking Member Esty, Chairman Roe, and
Members of the Subcommittee, thank you for the opportunity to
discuss my office's oversight of VBA's programs and operations.
I want to begin by detailing recent changes to our oversight
model for VBA that allows us to better review national policy
changes and focus on VBA's high-impact programs and operations.
Previously, we largely conducted oversight through
inspections of VBA's 56 regional offices. In October of 2017,
we implemented a new national inspection model for VBA
oversight. Under this new model, we now conduct nationwide
audits and reviews of high-impact programs and operations
within VBA with a focus on identifying the root causes of any
problems uncovered and making meaningful recommendations.
Since implementing this new model, we have published 15
oversight reports related to VBA. In these reports, we made 55
recommendations for improvement, identifying nearly $278
million in potential monetary benefits.
I want to highlight four recently issued reports related to
our oversight of VBA. In July, we reported on whether VBA
required disabled veterans to receive unwarranted medical
reexaminations. In August, we published the report that
examined whether VBA staff correctly processed claims related
to veterans' military sexual trauma prior to denying the
claims.
Also in August, we published the results of a nationwide
review of whether VBA staff assigned correct effective dates
for compensation benefits for veterans using the recently
implemented Intent to File process. And last week, we reported
on whether VBA accurately decided veterans' claims involving
service-connected ALS, also known as Lou Gehrig's disease.
These reports identified common systemic issues that
contributed to our findings. The primary root causes of the
problems we found were deficient internal controls, inadequate
program leadership and monitoring, a lack of information
technology system functionality, and the unintended impacts of
VBA's National Work Queue implementation.
To be clear, we believe that recent VBA initiatives and
policy changes were well intentioned to expedite the benefits
delivery process. However, these reports revealed that VBA
leadership's emphasis on efficiency has affected the ability to
review and process claims accurately. As detailed in our
reports in my written testimony, these recurring deficiencies
resulted in the inadequate delivery of services and inaccurate
benefits rendered to veterans.
We understand that VBA's leadership has been taking
numerous actions for the last several years to address the
changing and growing demands for benefits and services and to
reduce the claims backlog. However, the recurring deficiencies
we identified are often the result of VBA leadership making
management and operational decisions without fully considering
and planning for potential unintended consequences resulting
from their actions.
These include sacrificing accuracy for timeliness, rolling
out national initiatives after small and short pilot programs,
and implementing programs that do not have fully developed IT
systems and robust internal controls.
For example, VBA's Intent to File initiative had a short 6-
month implementation and delivery period. Errors generally
occurred because VBA did not take the time to set up adequate
standard operating procedures before implementing the new
initiative. Additionally, VBA's IT system lacked the
functionality to assist rating personnel in assigning correct
effective dates for benefits for Intent to File claims.
Since nationwide implementation of the Intent to File
process, VBA has taken steps to improve its control activities
and IT functionality, which has resulted in improved accuracy.
But the errors that occurred during the initial implementation
period will have to be reviewed and corrected, requiring the
use of additional VBA resources.
We believe VBA's implementation of our recommendations will
help limit the unintended consequences of VBA's policies and
programs and better position VBA to provide services to
veterans and their families in the most effective and efficient
manner possible. VBA has generally concurred with the 55
recommendations we have made under our new national inspection
model and has provided acceptable action plans.
VBA must now follow through with the difficult work of
implementation if they are to carry out the responsibilities
effectively and be good stewards of taxpayer dollars. We will,
of course, monitor their progress.
Mr. Chairman, this concludes my statement. I would be happy
to answer any questions that you or other Members of the
Subcommittee may have.
[The prepared statement of Michael Missal appears in the
Appendix]
Mr. Bost. Thank you, Mr. Missal.
With that, we are going to begin questioning. And I will
allow myself 5 minutes to start off.
But let me first off also say, Dr. Lawrence, that your
announcement of making it very clear to us and to the public
that it is to make all of our GI veterans whole and/or also
then not to--and hold them harmless for those who may have been
overpaid is a good start for this hearing. And let me tell you
that I believe that it will also calm down a lot of the
questions that would have probably come up here today.
That being said, we do have some real issues that we have
got to deal with. And I am going to go a little off script here
because I know the question I want to ask, but I want to
express it this way. I know you came in in May. But the--I was
a full-time firefighter, and I can remember my first night on
duty. And the fire chief came in and he says, Mike, I want you
to know something. He said, you are in a job that there is
going to be a lot of problems and you are going to. You didn't
create the problem. You have got to fix it, though. Whatever
you do, don't make it worse. Whatever you do, don't make it
worse. Okay?
Let me simply ask, how are you planning to change the
culture from the VBA from its present issues that arise from
this systematic lack of planning and effectiveness and how to
implementate things going forward, not only on past projects,
but on new projects?
Mr. Lawrence. I am going to change the culture by modeling
different behavior. And let me explain. When I think about
these problems, I draw on my experience in the private sector,
just like you, sir. And what I observe and I take away from
this is sort of, you know, other general management
perspectives.
As Mr. Missal described, you know, decisions were made very
quickly and probably without the right amount of expertise in
the room to really appreciate it. I've slowed things down. So
decisions are made more deliberatively. I call it go slow to go
fast. We focus on fewer things and we spend more time thinking
about what the risks are and the potential unintended
consequences. And more importantly, or equally importantly, we
have more people in the room to make sure we have voices.
I take diversity and inclusivity very serious, but, to me,
it is not a skin color thing. Inclusivity refers to bringing
people with different perspectives into the conversation to
avoid the things we were just describing.
So those are the two things that drive my understanding of
how we are going to go forward. My leadership style. That has
been demonstrated from the very first time I showed up, even in
confirmation, when I talked about priorities and what we were
going to focus on.
Most importantly, you heard me make reference to the
director's conference, the leadership conference in September.
That is where we really did the work I am describing. Where
people came into the conference having prepared thoughts around
key topics, where we had rigorous discussion about what the
possibilities were. There were no talking heads in this
conference. There was real work being done till 8 o'clock the
2-1/2 days we were together.
And at the end of that, we put forth ideas about how we
would work on things, like rework, like quality. Everybody in
the room, all 76 people, got a star and got to go vote on what
we thought the best answers forward were.
Those were the projects we took down and are now working,
which will be harvested in the spring and beyond. So that is
the different behavior we are now doing.
So I think collectively, the good ideas in the room, you
know, really make me confident about the talent on the team and
what we can do differently going forward.
Mr. Bost. My next question is for Mr. Missal. You know, you
mentioned that the VA has historically exhibited systematic
problems associated with and how it implements policies
initiatives, such as inadequate training and complete IT
functions, deficient mitigation strategies and lacks quality
control. Have you identified other areas where the VA can
improve its foresight to better plan for the new policies
initiatives to avoid potential negative impact on claims
processes?
Mr. Missal. Yes. You have mentioned some of the more
significant ones that we found. One of the other issues that we
think is real important is communication within VBA, because
there are instances where one side involved in an issue may be
aware of it and the other side doesn't get that same
information. It is very hard to properly implement something if
everybody is not on the same page as to the information there,
what the goals are, what the process is, et cetera.
And so what we try to do in our reports, we not only try to
get it right, we try to be fair, but we also try to say what
the root cause is that we find. Because if a mistake is made,
we want to be able to point out that mistake so that it doesn't
happen again.
Mr. Bost. Okay. I am going to go ahead and turn over now to
Ranking Member Esty for 5 minutes.
Ms. Esty. Thank you very much.
And I am going to have a series of fairly specific
questions that I am going to submit for the record, but I want
to continue this line of discussion because I think it is
really important about changing the culture.
Things are happening quickly. You are being asked to do a
lot of new things in VA quickly. And we understand that can be
a lot, especially for an institution that coming out of a
military background doesn't always embrace change that quickly.
So you have got a mindset change you have to deal with.
I want to talk about the communication issue. How do we
ensure that that is happening? How do we disseminate those best
practices?
The National Work Queue was a huge undertaking. We should
be reaping the benefits of that now, but that means that
information has to be assessed and it has to be pushed back out
to all of the offices. So I want you to talk about that, as
well as specialization. I think that has come up on the quality
control, these more difficult claims, ALS being one, military
sexual trauma being another. They require specialization to get
right because of the nature of the trauma to the veteran
involved, the importance of doing those accurately, and while
it is just not fair or reasonable to think we should be
training each and every claims reviewer to do that. That is not
a good use of time and it should not be done.
So can you talk about, Dr. Lawrence, how you are going to
identify the areas that are going to require specialization,
what you are doing to make sure that happens so that you are
proactively, not just in response to an IG report, but how are
you going to track? What are those areas that require
specialization? How are you going to do that training? How are
you going to update the training so that we are continuing to
have best information and best practices disseminated across
the totality of the VA?
Mr. Lawrence. Let me start with specialization first,
ma'am. Yes, we agree. There should be more specialization. The
benefits of it are clear, and we should do more of it.
Probably early summer, unrelated to the report, we began to
think about how we process claims under the guise to be better
for veterans, and part of it was efficiency. We are identifying
which claims should be bundled in a specialized manner like
this. And so we have what we call lanes, and there is
specialization by virtue of this. We are trying to balance the,
you know, efficiency we get, the sensitivity, the caring and,
quite frankly, the right places we should do this around the
country.
This is something we are already working on, and we think
the benefits are clear. And as we discussed with you leading up
to this, to build on even some of the things we better
understand about the veteran experience. So we should do more
of that, but I want to be careful it won't be the answer to
every problem. But we see the benefits of specialization, and
we want to reap those.
We draw on best practices from some of the leading
companies, and they caution us to be careful because at some
point you can go too far. But we don't think we are anywhere
near close to that, based on the work we have done.
If I could just answer your other two questions. In terms
of communication, yes, ma'am, that was something I thought
about a long time. In any large organization, as you know, we
have 24,000 people, our construct is headquarters and then 56
regional offices around the country. We have tiers of people
and levels in between that we need to communicate with.
This also came up in our directors conference, and there is
a project that was just concluded about how we are going to
more formally communicate what the mechanisms are, what the
vehicles are, what the responsibility of everybody is to
participate, and then pass that information along. That will
not solve every problem, but at least we will begin to address
the awareness of issues pushing it out to everybody so we have
greater consistency.
And your last thing, I think, was the training, to make
sure we got it. And let me draw on Beth here because I know she
has been thinking a lot about this as we deal with that.
Ms. Murphy. Thank you, sir. We have really been empowered
under Under Secretary Lawrence's leadership to look for
different ways to do things.
As far as training, I think in the past we relied on a more
one-dimensional aspect of training, which is we put out a call
or we have a PowerPoint, materials, someone delivers that or
you do that online. These days, when you want to find out how
to do something, what I do, and I know a lot of folks do, is
you go online and you look for a video. I would rather have
someone show me how to do something rather than just tell me
how to do something.
So we are capitalizing on that with new technology and
tools and platforms. With the Intent to File, that was part of
the solution. We used a video to instruct folks how to look for
the effective date with the Intent to File, and we reap the
benefits down to a 4 percent error rate. And more recently, a 2
percent error rate.
We are doing the same thing with the military sexual
trauma. Rather than a PowerPoint, it is now a video that says I
am putting myself in the place of the military sexual trauma
coordinator. We are going to walk through the checklist, how to
develop for these cases, how to make these phone calls. So it
is a more dynamic three-dimensional training that folks can
access at their leisure. And it is mandatory, but then you can
go back and look at it for refresher as necessary.
Ms. Esty. Thank you. And I see my time is expired. Thank
you. I yield back.
Mr. Bost. Mr. Coffman, you are recognized.
Mr. Coffman. Thank you, Mr. Chairman.
Mr. Missal, what is the central problem here? We get this
all the time that, oh, how we are going to do things
differently, and at the end, they always fail, the VA always
fails. Is it that they never assess the requirements properly,
they don't manage contracts properly? What would you say is a
central reason for failure?
Mr. Missal. I think there are a number of different reasons
why these programs don't operate as effectively and as
efficiently as they should. And I think you can start first
with the planning phase. Do they do enough to plan? Do they
take the proper time? Secondly, do they determine whether or
not any IT that is going to go along with the program has the
proper functionality? Has it been properly tested?
Next, once it is implemented, what are the internal
controls? Because in a question of, like, communication, how do
we know it is working? If you are looking at it in hindsight,
you are looking at the controls to determine whether or not you
have issues there.
And finally, do a root cause analysis, so that if something
hasn't worked as anticipated, you take a look at it again, so
you don't make the same mistake.
So I think putting all those together, that is sort of a
general summary of the issues that we generally find.
Mr. Coffman. Does the VA, Mr. Missal, bring in outside
consultants, experts to be able to define--it is one thing to
have a contractor come in to implement a system; it is the
other thing to objectively define the requirements.
And it seems to me that, at least certainly when we looked
at the issue concerning the Post-9/11 GI Bill and the changes--
and we are going to be doing that in the second round, so I
don't want to really get into that now--but they were unable to
assess, number one, could they do it and said that they could
do it. And number two, even come up with a timeline. Number
three, they couldn't manage the contract and the contract
ultimately failed, is my understanding.
But is it they need professionals from outside the VA to
come in and write these requirements and manage the contracts,
or are they doing that?
Mr. Missal. In a number of situations, they do bring in
people from the outside. The VA has thousands of contractors
who are working at VA. And sometimes it is as simple as just
working together to make sure that when you have a contractor
working with the VA staff and systems, are they all integrated
well? And that is one thing we find is that sometimes the
integration is not what you would like it to be and then you
are sometimes working across purposes.
Mr. Coffman. Okay. Mr. Chairman, I yield back.
Mr. Bost. Mr. Bergman, you are recognized.
Mr. Bergman. Thank you, Mr. Chairman. And thank you all for
being here today.
These hearings are always informative, I believe, to all of
us. I am very appreciative, as I know we all are, of your
proactive nature in this.
People who serve in uniform have to be proactive by nature
because the mission requires movement, adaption, and overcoming
obstacles in order to succeed. And I would suggest to you that
any culture, whether it be here in the Congress or whether it
be in the VA or the Department of Defense, or anybody else
related to veterans, if they don't have that same culture of
adapt and overcome, we are going to have long-term failure.
Okay. So having said that, Dr. Lawrence, when you talk
about, if you will, revamping, revising, building a new culture
under your command, can you give me an instance of some of the
things you might be doing outside a norm, that of we have
always done it this way kind of thing, to build that culture
with those under your command?
Mr. Lawrence. Sure. One of the things we have done, and I
alluded to this in my opening statement, is really searching
hard for best practices in industry.
If you think about what we do, for example, we maintain an
insurance product line. We can learn from how the world-class
insurance companies learn and copy those behaviors that are
relevant. So I want to really draw on, leverage best practices
from around the world. I don't mean as good as it gets in
government. I mean world class elsewhere, because we can be
that good because the talent at VBA is that strong.
Mr. Bergman. Let me ask a question because--you know, I
appreciate that. Looking outside your organization for best
practices is what I heard. Do people come to work because they
have to or because they want to, under your command?
Mr. Lawrence. I don't know the answer for me specifically,
but I will tell you the survey of why VBA employees come to
work every day is the purpose of the mission of serving
veterans. We have had outside studies done of that prior to me,
and consultants come and talk to us all the time and say that
is a very powerful draw to why folks come to work at VBA.
Mr. Bergman. Okay. The use of contractors, how do--if you
have those who are on your payroll, if you will, as your
employees under your command and then you have this adjunct
group that melds into your organization for a time but not as
permanent employees, how, then--what do you do within the
culture that you are trying to create that will make those
contractors feel part of that team, that they are actually--
they are just trying to stay because they want to stay working
for the veterans. What kind of programs or policies or training
things do you have in place to bring those contractors in that
it is just one group, you can't tell who is the contractor, and
who is the employee?
Mr. Lawrence. So we focus on--when we use contractors the
way you are describing, because sometimes we use them for spot
solutions, right. They come, they assess something, and they
leave, so they wouldn't quite qualify for what you are
describing.
We focus on integrated product teams and try real hard to
get contractors who are also focused on serving veterans. As
you know, there is a requirement that we deal with generally
veteran-owned businesses, and that sets us in a very good
position as well. Many folks have traveled in and out of the VA
processes and they get it.
So really, we have seen people working closely together.
And quite frankly, we think VA is a good client to have if you
are a contractor or consultant, and people come to us and they
want to stay for long periods of time through the contractor
relationship.
Mr. Bergman. Okay. And one last question, because I see I
have about a minute left. Is there any current surge capability
that--or on the horizon for you as you build your organization
here going towards the future? Again, mission-oriented. We know
we have--you know, we are talking military language here, but
when you need a surge, is there anything in your plan to create
some level--doesn't have to be a lot necessarily--but that idea
within your organization that if you need to redistribute
assets for a short period of time, is there anything in your
plan that would indicate that that is part of it as well?
Mr. Lawrence. Yes, sir, there is. So, for example, in the
September-October timeframe when we were experiencing real
difficulties with the GI Bill, our call centers were
overwhelmed. We are staffed for 15,000 calls a day. We were
getting north of 25,000 a day.
I am looking at best practices for other call centers to
figure out what the surge capabilities are. Often they have
relationships with other external entities for situations like
this. Christmas, for example. So, yes, that is definitely part
of our plan, because I don't think the answer for our veterans
should be ``wait.''
Mr. Bergman. Okay. Thank you. And I yield back.
Mr. Bost. Thank you.
Mr. Banks, you are recognized.
Mr. Banks. Thank you, Mr. Chairman.
Dr. Lawrence, yesterday's news report regarding the Forever
GI Bill is deeply concerning, even more than when we heard from
you testify last before my Subcommittee, the Technology
Modernization Subcommittee, a couple of weeks ago. Your IT
systems continue to leave veterans in need. The mission of the
VA should not continue to be compromised because of a foible
like this.
What was the rationale behind you getting rid of the Booz
Allen contract? And why would you not just have Booz Allen hire
different subcontractors to do the job?
Mr. Lawrence. Sir, we have not made the decision to get rid
of Booz Allen, so that is inaccurate. That is being discussed
right now. They do many things for VA broadly, and they will
continue. I think we are trying to figure out how to redirect
them to the work they continue to do for =VA. So that is a
misnomer.
To get to your broader question, though--
Mr. Banks. Why don't we pause with that? How much have you
paid Booz Allen?
Mr. Lawrence. I don't know. I don't administer those
contracts. We can take that for the record.
Mr. Banks. Okay. Please do. Go ahead.
Mr. Lawrence. More broadly, I think, you know, my
recommendation for which the Secretary and others churned on
and accepted dealt on sort of three primary tenets, and this
was pretty clear to me based on my professional experience, as
well as just traveling through this journey that I arrived on
it.
We had real challenges with accountability, and so I
stepped forward and said I would be the person accountable for
implementing the GI Bill. We had difficulties with the program
management structure, so we will engage our FFRDC, Federal
Funded Research and Development Center, the special
relationship we have with the MITRE Corporation, to provide
conflict-free advice on the program integration, the schedule,
and help us manage it. And then we will go find a world-class
contractor to deal with the following: systems integration and
software development.
Two weeks ago when I sat here, you listened to the
contractor say, I do software development. We need to do
systems integration. You will recall I drew the chart with all
the boxes. That is what he was talking about.
In hindsight, we need a systems integrator and software
development corporation to help us.
Mr. Banks. Okay. Let me switch gears a little bit. One of
the issues that came up on the Committee staff's trip recently
to Muskogee GI Bill processing office was the problems that
processors were having with Microsoft Word and other Microsoft
systems.
It is my understanding that you were given a plan before
Thanksgiving from OINT to bring in a team to try to address
these problems. Have you acted on that plan? And if not, why
not?
Mr. Lawrence. Sure. We had a team there when I visited the
next week, so, yes.
Mr. Banks. What have they done? What has that team done?
Mr. Lawrence. They have been de-conflicting the software
and identifying workarounds to make it, so it does not lock up.
And that has been dramatically reduced. I am still concerned
that we are using workarounds versus a solution, so we are
trying to figure out whether we need to engage Microsoft, for
example. But, again, that has been--
Mr. Banks. So you are still trying to figure out whether or
not to engage Microsoft? What has that team accomplished? What
has come out of--
Mr. Lawrence. They are about 95 percent of the way there.
And the question is, you know, is it because we have
workarounds or we solve the problems. And that is still being
assessed.
Mr. Banks. When do you think we will be 100 percent of the
way there?
Mr. Lawrence. I don't know the answer. I will be happy to
come back and talk to you about it.
Mr. Banks. All right. I yield back.
Mr. Bost. Mrs. Radewagen, you have been recognized.
Mrs. Radewagen. Thank you, Mr. Chairman. I want to thank
the Ranking Member for holding this important meeting. I also
want to welcome the panel. Thank you very much.
My question is for Inspector General Missal. Are there any
of your recommendations in the MST report that VA is not
addressing?
Mr. Missal. I am sorry, that VA is not?
Mrs. Radewagen. Are there any of your recommendations in
the MST report that VA is not addressing?
Mr. Missal. No. They have concurred with all of the
recommendations and are in the process of implementing them.
And we will review that to ensure that they are fully
implemented.
Mrs. Radewagen. And, Dr. Lawrence, how are you planning to
address the rest of IG's recommendations? And when is the
timeline to complete these actions?
Mr. Lawrence. We are going to address them aggressively. We
have already started on some, so I know--let me draw on Willie
here because he actually implements the plans we have.
Mr. Clark. Good morning. We have a several-pronged approach
to dealing with the MST. Beth spoke earlier on the training. We
are updating the modules in a YouTube type of effect. We also,
Beth, we have updated the manual, mandating the use of a
checklist that all of our claims processors are supposed to use
or will use. We are mandating a checklist for them to use. That
way it will improve upon our quality if they are guided into a
step-by-step process of what they need to do for the
appropriate development of that case, and to rate the case.
We also have identified coordinators for MST for each of
our regional offices. We have conducted training, all of which
has happened. We completed some training in September, in the
end of last month. We have another set of training that is
supposed to be done--or has been completed at the end of this
month. So every one of the recommendations, we have
implemented.
Mrs. Radewagen. Thank you, Mr. Chairman. I yield back.
Mr. Bost. Thank you.
I see that our colleague, Representative Peters, has joined
us here, and I would like to ask unanimous consent that
Representative Peters be allowed to sit at the dais and ask
questions.
Hearing no objections, so ordered.
Mr. Peters, you are recognized.
Mr. Peters. I am going to pass this round.
Mr. Bost. Chairman Roe.
Mr. Roe. I want to just get a couple things clarified. And
this GI Bill is complicated. So that I understand and so that
our students out there understand, Dr. Lawrence, is that when
the law went into effect August 1, it contained two sections,
107 and 501. And as I understand it, the 501 section is a COLA,
it is the cost of living adjustment. The 107 section is where a
student would be paid a per diem based on where the bricks and
mortar campus is. And then lastly, the online students are paid
at a different rate.
So am I correct on all that? Do I understand that right?
Mr. Lawrence. That is correct.
Mr. Roe. Okay. And I want to make sure that I understand
that when the law states that all this goes into effect on 1
August of this year, 2018, are we saying, and maybe I
misunderstood you, but are we saying that the 107 provision and
the 501 provision will be made whole, those students under both
those provisions, will be made whole as of the law was stated
on 1 August? Am I correct on that?
Mr. Lawrence. We are going to go back into the fall of 2018
and make sure they get the DoD uncapped rates.
Mr. Roe. Back, again, are we going to--are we going to
follow the 107 section of law which says where the bricks--like
a student, for instance, let's say the student is going to
college in San Francisco. It has a much higher per diem than if
they went to college where I did in Clarksville, Tennessee,
which is a per diem that would be less than half or a third of
that much. That student who took the majority of their classes
in Clarksville will be paid a certain per diem. Am I correct?
Mr. Lawrence. That is correct.
Mr. Roe. And then the student who would be in San
Francisco, which is obviously much more expensive to live
there, we are going to go--because those payments may not be
correct right now--are we going to look back and follow law and
pay them going forward? Then what is the discussion about
changing the statute to December of 2019? That is what I don't
understand. If we are going to go back and make 107 and 501, we
are going to follow that, then what is the point in moving it
forward? I know it is a lot of work and it is complicated, but
I want to make sure we get it straight here today for the
people.
Mr. Lawrence. Sure. So this fall, we are using the 2017
rates. We need to use the 2018 rates. That is the true-up we
are doing.
When we implement the law, the Forever GI Bill in December
of 2019, we will not use the ZIP Code. We will be using the
definition of campus, and that is what we use going forward.
Mr. Roe. But the law states now that in August 1 of now we
should be doing that, correct?
Mr. Lawrence. That is correct.
Mr. Roe. So, again, why wouldn't we follow the--because
there are going to be a group of students that for at least 1-
1/2 academic years are not going to be paid correctly and are
not going to be trued-up? Am I right on that?
Mr. Lawrence. No. They will be trued-up for this fall.
Okay. It is not clear what the difference will become the
implementation.
Mr. Roe. Maybe none.
Mr. Lawrence. Maybe none. We will have to assess the burden
on schools to go back. We will have to assess the burden on
VBA, and we will have to figure out the benefits to folks we
are describing. It is not clear there will be any difference
under this interpretation of what a campus is.
Mr. Roe. And again, I am not trying to overdo the point,
but if we follow the law as is, then you have got to go back
and look. It creates, I realize, a lot of work to do that, I
understand that, to go back and make sure that those students
who started class in the fall semester in August of this year
are going to be made whole, according to the law as it was
passed August 1, and stated in law August 1 of 2018.
Mr. Lawrence. Right. We will seek to work with you and your
staff to better understand whether that is in the best interest
of veterans, given all the work you described, the potential
low benefits from doing that, quite frankly.
So I think we need to figure out whether we need to come
back to you and ask for a legislative change to push the date
to December 1 or not. It is not our intention to harm veterans.
We also have to think about the broad veteran population and
whether what you are describing yields any benefit, just work.
Mr. Roe. Well, I think--anyway, we will continue this. I
will go ahead and yield back, but I want to make sure that we
off-mike work through this and just see how many veterans we
are talking about. Because there could be some that we have
underpaid out there, and probably are veterans that have been
underpaid. And we want to make sure that those veterans get
what they earn and what the law stated.
I yield back.
Mr. Bost. It is the chair's intent to have a second round
of questioning. The second round of questioning will be a 3-
minute, so the Members know.
So recognizing myself, because we really want to focus--
this GI thing is big, okay. And we want to know, and I think
the people deserve to know, because when Representative Banks
asked, there was still some confusion on the statements, I
guess, that were made yesterday. And you clarified those, and I
appreciate that.
That being said, how many--what is our actual number of
GIs--that are receiving the GI benefit at this time?
Mr. Lawrence. I don't have the exact numbers in front of
me, but when I was here 2 weeks ago, I said it was 450,000,
approximately.
Mr. Bost. Do we know an approximate error ratio or how many
people are being affected and which ones were underpaid? I know
we can't get exact number but--
Mr. Lawrence. No. That is part of the problem, without the
technology, we were unable to do anything but estimate that
broadly, and I am not so certain those were accurate estimates
because of the way the changes were going through.
Again, I apologize I don't have subject matter experts
here, but I would be happy to take questions for the record on
the GI Bill as we get to--
Mr. Bost. Okay. Then the question I have on top of that is,
as you go back and try to figure out these errors and then live
up to the commitment to make someone whole, is it going to have
to be done through the tech people that you were working with
originally? Because the statement--was it Booz and--the
contractor's--are they going to have to be able to pull that
out or can your staff pull that out and figure that--
Mr. Lawrence. Sure. The--sorry, I didn't mean to cut you
off, sir. The technology is in place to do the true-up I've
described for the fall of 2018. The next two weekends, we will
load the 2018 rates, we will compute them. And folks who were
short will get a check in January for the difference.
Mr. Bost. Okay. I think another concern is where the
Chairman was asking as well, this confusion about what your
home ZIP Code is but where you were actually located and then
getting the proper per diem is vitally important, especially
whenever the law has been written, and so that is what we will
do to make sure that everything is caught up and done
correctly. And trying to get--I want to know from this
Committee's standpoint that we have the commitment that that is
going to be the case where your staff--your group as a whole is
going to be aggressive to make sure that anyone that is owed is
found out that they are owed and then made whole in each one of
the areas.
Mr. Lawrence. So, yes, generally, but let me work
specifically on this. There is a couple things going on here in
the new path forward.
One of them is returning to the definition in the law of
what a campus is. It is a building owned by an institution.
That is different than the ZIP Code thing we explained where
students could do an interim. This is different. That
difference will go into place December 1, 2019, for the spring
semester of 2020.
When we asked to go back, it is not clear what the
differences will be, and that is what we have to figure out and
work with your team to figure out, is all the processing going
to end up with one person getting a check for a dollar. We
don't know that yet. It is not our intention to harm veterans,
but it is also our intention to process the GI Bill effectively
and accurately going forward.
Mr. Bost. Okay. I am out of time.
Ms. Esty.
Ms. Esty. Thank you, Mr. Chairman.
Again, I think we need clarity on this. And this is, again,
an example of we had an intent in the law, veterans may have
understood that to be a certain way, so we may still have an
issue. You may look at the law and say, well, we interpret it
this way. I assure you, we are going to have constituents who
will say that is not what we thought that to mean.
So we need to be in close communication as you look at what
is an error, to understand there are going to be veterans who
believe that they were promised this, and we need much greater
clarity. And that takes me to sort of the second point.
The IG noted that some of these systematic problems going
back, and I am thinking now with our hearing next week, we have
got appeals modernization rolling forward. So what are we going
to do, not only on the Forever GI Bill, but on appeals
modernization to be looking at that IT capacity and knowing
what the requirements are so that we are not faced with exactly
the same kind of situation with appeals modernization where we
are having to go back and redo and rerun and rework, which is
one of the core things we need to stop doing, is having so much
need for rework?
So if you can address what is being done now. Are we doing
beta testing? How are we going to ensure that we understand the
needs the system will have from an IT point of view that we
aren't, you know, learning by the seat of our pants having done
a national rollout and actually not being ready to do that?
Mr. Lawrence. I don't want to steal the thunder from the
team that will appear before you next week on appeals
modernization, but they will tell you a very positive story
with technology. The system is in place and they are doing end-
to-end testing exactly the way you are describing.
I will tell you that the takeaway from my confirmation
hearing were the two things that I should worry about going
forward were the GI Bill and appeals modernization. And after I
was in office for 1 week, I started meeting with both teams
every week for an hour to understand the state of what is going
on.
I will tell you that in terms of appeals modernization, you
see a very different experience. The team began working
together 3 years ago. The systems we used are some of the most
mature, and the technology we use is new and invented just for
this purpose.
So far along the way all tests have been passed. I am very
positive. They will tell you more about it next week, I
believe.
Ms. Esty. Well, I hope we can take the lessons that are
being learned there and make sure that those are used every
time with forward-going programs. And to the extent we can,
then put this back into the Forever GI, or at least maybe we
cut that off and start over again with the kind of design we
are doing to benefit from this approach. Because I think
sometimes trying to bootstrap and rework a system that is not
working well is not a good way to go. I am just going to put
that out there as something for you to consider.
Thank you, and I yield back.
Mr. Bost. Mr. Coffman.
Mr. Coffman. Thank you, Mr. Chairman.
Dr. Lawrence, first of all, if you are unable to meet the
statutory requirements that are very clear, you need to come
before the Congress of the United States to have those altered.
You can't simply change the law yourself, if you are unable to
meet the obligations that your department agreed to and the
Congress of the United States mandated through law and the
President of the United States signed.
Let me ask you this. How many senior executive service
positions do you have in VBA?
Mr. Lawrence. I don't know the exact number. It is
approximately 100, I would guess, but I will get you the exact
numbers.
Mr. Coffman. You have been there for 6 months. How many SES
positions have you let go?
Mr. Lawrence. I think the answer is zero.
Mr. Coffman. Really? Because I have had a conversation with
our new Secretary and followed up in writing to him that there
are about 400 positions in the senior executive service level
in the Department of Veterans Affairs.
After the scandal with the appointment wait times, on a
bipartisan basis, the Congress of the United States passed and
President Obama signed the ability for you and for the senior
leadership of this department, the Department of Veterans
Affairs, to expeditiously let go senior executive service
personnel that were not competent.
In my discussions with the Secretary, he is unwilling to
make that commitment to do that, to look through these 400
positions where there is objective failure and the inability to
correct that failure by inspector general reports, by GAO
reports. And yet you will never change the culture of
bureaucratic incompetence in the VA unless you are willing to
look through those 400 positions. And where there is a lack of
competence, where problems are unresolved, that you are
unwilling to make those hard decisions, which our Secretary is
not willing to do, which you obviously haven't done, then
nothing will change.
This President will fail the country in terms of the
commitments that he made to change the VA. He changed the
Secretary, but that was on the basis of his record in terms of
personal spending or spending taxpayer dollars on a European
vacation. It was not on his competence in terms of running the
VA. This is the same VA of the prior administration, just
papered over with saying how great things are when they are not
great.
I yield back.
Mr. Bost. Mr. Lamb, you are recognized.
Mr. Lamb. Thank you, Mr. Chairman.
If it is okay, I am going to go back to one of the issues
that this hearing was called for having to do with processing
of benefits claims. In particular, our VAs in Pittsburgh
process claims involving military sexual trauma. And I know--
well, I guess you can confirm for me if I am correct, that each
office is supposed to have a specialist dealing with military
sexual trauma claims. Is that true, Mr. Clark?
Mr. Clark. Good morning, Mr. Lamb. That is true. We have
specialized individuals for military sexual trauma at each RO.
That is true.
Mr. Lamb. Okay. And have you been able to fill all those
positions? Are they full as of right now?
Mr. Clark. They should be full, yes. We have military
sexual trauma coordinators that are full. If for some reason,
someone left yesterday that, you know, that I don't know about,
but, generally, our leaders know to keep those positions filled
and to make sure that they receive all of the requisite
training and quality measures are filled in order do this work.
They are not to do the work on an MST claim unless they have
had the requisite training and they follow the guidelines that
we have set forth with this checklist and viewing the trainings
materials and the like.
Mr. Lamb. Okay. Are they overseeing examinations for
military sexual trauma done by contractors or more done by VA
personnel?
Mr. Clark. For the most part, contractors.
Mr. Lamb. Okay.
Mr. Clark. But there are some instances where VHA doctors
perform these examinations. And again, VHA sometimes uses
contractors as well.
Mr. Lamb. Have you looked at the outcomes or quality of
those examinations to see whether the contractors are doing an
adequate job? Because I think this is an area where the VA's
doctor's kind of particular training and familiarity with this
population and this type of claim would really help.
Mr. Clark. I would certainly let Ms. Murphy speak to that.
Ms. Murphy. So, sir, I think it has generally been about a
50/50 split overall with exams as far as VHA versus
contractors. I think we both entities, VHA and VBA, watch
closely who is doing the exams and has quality controls,
checking the reports.
So I can't, in the moment, speak to the specifics, but,
yes, both sides are watching, both sides are engaged in this
work.
Mr. Lamb. Okay. Thank you very much.
Mr. Chairman, I yield back.
Mr. Bost. Thank you.
And, Mr. Bergman, you are recognized.
Mr. Bergman. Kind of to continue on with my questioning
along the line of building a culture. As we look at the GI Bill
going forward and the payments and the coordination between the
VA and the educational institutions--not the veteran, but the
educational institutions--about a year ago, we had a hearing in
here where I brought up the concept of in the brain core, the
sand table exercise. And we did a little, you know, back and
forth on that. But the idea of is there--and by the way, this
Committee, bipartisan, is going to be the best partners that we
can be with you, because we want results just like you do. Of
course, it is our job to give you the money and then hold you
accountable. It is your job to execute the mission.
Is there anything that we can do for you to, if you will,
to participate in a--I am going to call it a sand table
exercise that the goal of this exercise would be to see where
the system can be gamed, whether it be accidental or on
purpose, on either side of the equation? Because unless we take
what we are about to implement and then put it into exercise to
see and put the--I know all these minds on all sides of the
table are smart, motivated, and potentially devious, okay?
Because I have kids. I have grandkids. You know, that is how it
works. And it is up to us to make sure that we make--that we,
if you will, close accidental loopholes that cause others pain.
Pain of loss of dollars or pain of loss of credits or whatever
it happens to be.
Any thoughts on where we can do that? Or maybe that is
already in your game plan.
Mr. Lawrence. Yes and yes. Absolutely want your help. A
couple things immediately come to mind. One of them is when we
do the user testing, to sort of, you know, get examples of
veterans that we think we need to make sure the system works
for. So I know your staff has been great sort of identifying
people who call you and say I am having trouble, so we do that.
In addition, I am sure the new plan going forward, we will
spend a lot of time with you explaining things. So I think
there is probably, you know, reason for engagement as our
interpretations of some of the things that require and to make
sure that we are coordinated on that as well.
Mr. Bergman. Okay. Well, again, I see my time is about to
run out, but engage us early because the sooner we engage and
the sooner we pick it apart, the less we are going to have to
have hearings like this after the fact.
And I yield back.
Mr. Bost. Thank you.
Mr. Peters, you are recognized.
Mr. Peters. Thank you, Mr. Chairman.
Dr. Lawrence, I just want to make sure I am clear on
exactly what you're saying about Section 107 of the Forever GI
Bill, which we passed last--or this session.
Section 107 is the section dealing with students being paid
according to where they are taking the majority of their
classes. And are you testifying right now that after the VA
finally implements Section 107, that they will go back and
recompute what students would have been paid had Section 107
been in place by the August 1, 2018, deadline in the law, and
if they were underpaid between August 1, 2018, and when the
section is finally implemented, pay them the difference to make
them whole?
Mr. Lawrence. What I am testifying to is that we will go
back into the fall of 2018, put the right rates in and make
sure they get a check in January if they have been underpaid.
What changes as we go forward and think about December of
2019 is the way we thought about campuses. If you recall, there
was a long discussion about ZIP Code in practicums--
Mr. Peters. Right.
Mr. Lawrence [continued].--and that set-in motion some
expectation of overpayments or underpayments and the like.
When we return to the definition of campuses defined by the
law and our interpretation of it, it is not clear there is
going to be any changes. We have got to figure out what the
implications of that are and then go back or not as
appropriate.
Mr. Peters. So what you are suggesting is that there are
some--you are having an issue with interpreting the law as to
whether money is owed?
Mr. Lawrence. A couple thoughts. We are not interpreting
the law. The law is pretty clear. It defines campus a certain
way, and we are going to go execute that.
Mr. Peters. Right.
Mr. Lawrence. It is not clear that--possibilities. What are
the possibilities? There could be wide-scale variation, and we
have to go back for exactly the way you described. There could
be no variation and the going back would be energy that would
be better spent processing claims going forward.
That is the unknown we have to figure out, and quite
frankly, work with you on too. It is not our intention to harm
people the way we are imagining. It is our intention to process
efficiently.
Mr. Peters. I want to get the sense of--it sounds to me
like you are leaving yourself some flexibility as to whether to
do that or not. Maybe you are assessing whether it is worth the
trouble to go back in following the law as it is written. But
we would like to know whether these people are going to be made
whole by that formula. And I am having trouble getting that
answer out of you, it sounds like.
Mr. Lawrence. We want to make people whole. I am not trying
to give you trouble. I am just trying to not give you a blanket
statement that requires tremendous activity for no gain.
So if you ask me what should we spend an extra hour on,
processing things that yield veterans nothing, putting at risk
the spring 2020 semester, or saying this doesn't yield much and
we are going to move forward. We just have to figure it out.
It is not my intention to be evasive. It is my offer to
work with you to make sure we all come away feeling this is the
right way forward.
Mr. Peters. What are you telling veterans and students now
who are going into the process going forward? What are you
telling them now to do?
Mr. Lawrence. We are telling them you will get trued-up for
the fall of 2018 with the right rates. We will execute the new
law in the spring of 2020.
Mr. Peters. Okay. Thank you. My time is expired. I yield
back.
Mr. Bost. Chairman Roe.
Mr. Roe. I want to go back with what Mr. Peters, the line
he was taking. And I am not trying to be difficult, but the law
states what we must do on 1 August. It is not an
interpretation--like you said, it is fairly clear what the law
states.
The question is, are we going to follow the law? That is
the question. And if we are not, then we have got to change the
law. It has got to be changed to a different time. Otherwise,
you are required by statute to go back and implement Section
107 and 501, as stated in the law. Am I correct?
Mr. Lawrence. That is correct. And previously, I made a
request for your help to do exactly that, if that is what we
conclude based on the energy that it would take for potentially
not much gain. We completely agree.
Mr. Roe. How would we know--I guess that is a question I
have. I am putting myself as a student out there at somewhere,
sitting there thinking I have a benefit that I have earned. Am
I getting paid correctly for my benefit? Am I getting unpaid?
How do we determine it is too much trouble to follow the law?
Mr. Lawrence. Let me--
Mr. Roe. How is that--do you follow? I am not trying--
Mr. Lawrence. I understand what you are saying. And I
appreciate that you admit you are not trying to be difficult.
And I don't mean to be difficult either. I am trying to be
precise in my answer.
When we adjust the rates for fall to the 2018 rates, we
will have honored the obligation. Nobody has yet been paid
under this system that doesn't exist. So there isn't a feeling
of I am owed something, unless they have been able to calculate
something that we have been, quite frankly, unable to
calculate. Okay?
When we put the new system in, we will know what that is.
Somewhere along the line as we begin to see it coming into
focus, we will make an estimate of what you are just
describing, what is the difference and what should we do about
it. And that is what we will have to continue to talk to you
about.
Mr. Roe. So basically, what we did was, just for clarity,
we stood up a system that didn't work and paid people what we
had paid them in the past, and we don't know what we should
have paid them. Am I correct?
That is pretty much what we did. Because our IT system
didn't work. That is what happened.
Mr. Lawrence. Notionally, correct. That is correct.
Mr. Roe. Yeah. I yield back.
Mr. Bost. Well, I want to thank the panel for being with
us. We did two rounds of questioning, and we have another panel
that is coming forward. But thank you for being here and thank
you for the opportunity to say that you will come back and try
to work with us to try to straighten this out.
Thank you.
Mr. Bost. So we do want to invite the second panel to the
table.
Okay. On our second panel, we have Mr. Michael Figlioli,
the Deputy Director of National Veteran Services for VFW. We
have Mr. Shane Liermann, Assistant National Legislative
Director for DAV; and Mr. Greg Nembhard, the Deputy Director of
the Veterans Affairs and Rehabilitation Division for the
American Legion.
Thank you all for being here.
Mr. Figlioli, you are recognized to start and give your
testimony for 5 minutes.
STATEMENT OF MICHAEL S. FIGLIOLI
Mr. Figlioli. Thank you, Mr. Chairman.
Chairman Bost, Ranking Member Esty, Members of the
Subcommittee, on behalf of the VFW, thank you for the
opportunity to testify on VA's methods for developing and
implementing policy changes for VA claims.
The VFW National Veterans Service established in 1919
begins its second century of service. VFW is encouraged by the
VA's efforts to modernize the disability claims process.
The VA has a number of challenges to overcome. However, we
feel the process is headed in the right direction. Our
philosophy in dealing with VA's bureaucracy has always been
praise when you can, be critical when you must.
Lately, we have found ourselves more on the critical side
than we would like. VFW has consistently held the VA's speeding
to completion of its workload for the sake of reducing volume
is precarious for both VA and our claimants. It does no good to
deliver benefits to veterans faster if the decisions made are
incomplete or inaccurate. It is futile to implement policies
for the sake of implementing policy and declare mission
accomplished.
Over the last 3 years, the VA has rolled out programs that
were intended to alleviate a number of claims and appeals-
related issues. VFW and our partner VSOs cautioned the VA on
numerous occasions about the pitfalls of rapid development.
We are appreciative of the VA's efforts in seeking VSO
input for newly developed platforms. Despite repeated attempts
urging the VA to assess shortfalls and take corrective action
before implementation, we have seen the VA forced to play
catchup time and time again.
VFW has been concerned since the implementation of the
National Work Queue. Why do some claims seem to move smoothly
through the system while others are bogged down due to
misunderstood guidance or improper application of the law? We
have not discerned why, other than pointing to inconsistency in
the system. Up until the decision was made to level the playing
field, we had the ability to mitigate irregularities at the
local level.
Since the implementation of National Work Queue, VSOs have
been restricted more than ever in locally resolving problems at
the regional office, such as the example we cited from
Pittsburgh where our local advocate was told by RO leadership
that calling the White House hotline was the only way they
could move on a claim that required significant attention.
In my many years as an accredited VSO, this is one of the
most absurd responses I have heard from VA staff on an issue
that could have been easily resolved. To be frank, the VFW has
been doing this longer than the VA. We pride ourselves on the
advocacy we provide to our claimants.
But what happens when the VA no longer permits its
employees to do the right thing locally? I fear that the drive
to National Work Queue, while well-intentioned, has only
amplified problems with the VA's inconsistency. The goal was to
level the playing field, to ensure veterans receive consistent,
timely, quality decisions. The playing field is certainly more
level today but not in the way we intended.
Instead, we see shoddy work from all corners of the VA,
with little accountability for what has gone wrong in the
process. We see our leadership that is hamstrung from doing the
right thing because it makes the national system look bad.
Regarding the recent IG reports, they all point to sloppy
development at the regional office and significant gaps in
training. None of what the IG found came as a surprise to VFW,
and this is no way to serve veterans.
As with any new implementation, training is paramount to
success. This is a persistent shortcoming in VBA. Across the
VFW's field offices, our staff see little consistency in the
application of law or the Code of Federal Regulation. VFW is
acutely aware of instances where intent of a regulatory change
is crystal clear, but applied irregularly at the majority of
ROs, whether it is the acceptance of electronic signatures,
recently updated forms, or simply processing dependency claims.
As we discussed in detail in our written statement, if the
VA is fully committed to establishing a fully electronic and
efficient claims process as they have touted over the past few
years, they need to ensure consistency across all regional
offices.
In all the scenarios we outlined in our prepared testimony,
VFW maintains that proper training will result in better
outcomes for the VA and its customers. The VA needs to get it
right the first time every time. The welfare of our veterans
requires it. If quality training is not developed, implemented,
and overseen, veterans and their families pay the price.
As said in our opening statement, VFW has been embedded in
the claims process for longer than the VA has existed. We have
always been able to provide a local mediation to assist the VA
in getting it right only to be told in the name of efficiency,
we can no longer do that. With the inconsistencies the VFW has
seen recently, it becomes clear the policies and innovations
the VA seems extraordinarily proud of don't exist in the eyes
of veterans and family members who continue to suffer delays
and denials.
In closing, the VFW does believe the VBA is headed in the
right direction in establishing a fully electronic and easily
accessible claims process. However, the VA still has
significant problems in the system that need to be addressed,
starting with the unrealized efficiencies of National Work
Queue and the seeming lack of authority for ROs to resolve
issues at the lowest possible level. We hope this Subcommittee
takes a hard look at these issues and works to resolve them in
a way that truly benefits veterans.
Mr. Chairman, this concludes my testimony. The VFW thanks
you and the Ranking Member for the opportunity to testify on
these issues, and I am prepared to take any questions you may
have.
[The prepared statement of Michael Figlioli appears in the
Appendix]
Mr. Bost. Thank you, Mr. Figlioli.
Mr. Liermann, you are recognized for 5 minutes.
STATEMENT OF SHANE L. LIERMANN
Mr. Liermann. Thank you.
Chairman Bost, Ranking Member Esty, and Members of the
Subcommittee, thank you for inviting DAV to testify at today's
hearing on VA's implementation of policy initiatives and the
challenges identified in the three recent OIG reports.
We are deeply concerned over the findings of the
significant deficiencies in these reports from July and August
of this year. The reason for these substantial errors can be
broken down into three main categories: training, IT systems
development, and quality review.
For example, the unwarranted medical reexaminations for
disability benefits report estimated that during the 6-month
review period, VBA spent over $10 million on examinations not
required by VA policy. The reexaminations resulted in proposed
benefit reductions for 3,700 veterans.
The OIG determined the main reasons for the unwarranted
examinations were lack of pre-examination review, lack of
system automation, and inadequate quality assurance reviews.
The report on processing inaccuracies involving veterans'
Intent to File submissions for benefits found that 97 percent
of the cases reviewed with errors resulted in underpayments. On
a national level, this resulted in an estimated $72 million in
underpayments to veterans and their families.
The reasons for the ITF processing errors were noted to be
an absence of standard operating procedures and inadequate
procedural guidance, deficient and delayed training, lack of
quality assurance, and a lack of IT development as VBMS lacked
functionality.
In reference to the OIG report on denied PTSD claims
related to military sexual trauma, VBA staff did not always
follow policy and procedures, and as a result, they incorrectly
processed approximately 49 percent of the MST-related claims
that were denied during the review period.
The reasons the MST-related claims were incorrectly
processed were a lack of previous specialization, lack of
additional review, and discontinuance of specialized focused
reviews, and inadequate training.
In all three OIG reports, these errors could have been
mitigated with the adoption of a VBA-wide strategic formula to
apply prior to implementation of any new changes processes,
benefits, or IT systems.
As demonstrated, VBA's erratic training, lack of planning
for IT systems development, and uneven quality review has
wasted millions of taxpayers' dollars, as well as underpaid,
denied, and reduced thousands of veterans. The VA needs to
develop proactive measures to lessen these deficiencies in
future projects.
We recommend VBA to create a systematic strategic review
process for new policies and initiatives. This could encompass
each appropriate VA office potentially impacted by any of the
new policies, such as the VA Office of Training, the VA Quality
Assurance and Review, IT services, to include VBMS and the
National Work Queue. However, to be truly effective, it
requires VSOs and other stakeholders, as well as VA's frontline
subject matter experts, including RVSRs and VSRs.
A good example is how VBA, VA agencies, GAO, VSOs, and
other stakeholders were all engaged from the beginning in the
development of the Appeals Modernization Act.
Before its implementation, VBA and BVA have collaborated to
develop IT infrastructure, training programs, and quality
review. This type of proactive strategy will lessen the
preventable errors noted by the OIG.
Mr. Chairman, the need for this type of strategic review
process is, again, reaffirmed by the most recent OIG report
released just last week. The accuracy of claims involving
service-connected ALS report projected that 45 percent of the
ALS claims completed during the 6-month review had erroneous
decisions. And once again, OIG recommended that VBA provide
additional training, better quality review, and add
functionality to VBMS.
A systematic strategic review process would focus on
vetting new policies and initiatives to prevent these
unintended consequences that negatively impact veterans and
their families. It would be better for the VA to invest time
and resources preventing these problems from occurring, rather
than developing workarounds and patches after veterans have
already been harmed. This pattern of systemic failures will
continue unless action is taken.
Mr. Chairman, this concludes my testimony. I would be
pleased to answer any questions you or any Members of the
Subcommittee may have.
[The prepared statement of Shane Liermann appears in the
Appendix]
Mr. Bost. Thank you, Mr. Liermann.
Mr. Nembhard, you are recognized for 5 minutes.
STATEMENT OF GREG NEMBHARD
Mr. Nembhard. The American Legion remains 100 percent
committed to our veteran community and believe that our
Nation's heroes should not suffer at the hands of institutions
whose existence and mission is to care for them.
Chairman Bost, Ranking Member Esty, and distinguished
Members of the Subcommittee on Disability Assistance and
Memorial Affairs, on behalf of our national commander, Brett
Reistad, and the nearly 2 million members of the American
Legion, I thank you for the opportunity to testify on the
Department of Veterans Affairs development and implementation
of policy initiatives.
We believe in quality of care at the VA facilities. We
remain committed to a strong VA, and we believe that the VA is
a system worth saving.
Since 2003, the American Legion has conducted more than 500
nationwide visits to VA medical centers and regional offices to
assess the quality and timeliness of veterans' health care and
provide feedback from veterans about the care and service
provided by the VA.
We compile reports from our visits into a publication for
distribution to the President of the United States, Congress,
and VA officials. This comprehensive report provides an
understanding of VA challenges, best practices, and offers
recommendations based on our observations and our nearly 100
years of experience.
The Department of Veterans Affairs Office of Inspector
General recently published three reports addressing unwarranted
medical reexaminations, processing inaccuracies involving
veterans' intent to file for benefits, and denied post-
traumatic stress disorder claims related to military sexual
trauma.
The VA OIG reports cited inaccuracies, timeliness issues,
lack of specialization, inadequate training, and overall poor
quality of VA examinations completed by contracted medical
examiners.
The American Legion wants to protect veterans from these
and other inadequacies and urge the VBA to take swift,
corrective action. We believe that a variety of factors cause
these shortfalls, including lack of funding, understaffed VA
facilities, and contracting companies solely focused on their
bottom line at the veterans' expense.
Mr. Chairman, through American Legion Resolution No. 87, we
support the implementation of policy aimed at ensuring veterans
receive adequate, comprehensive VA examinations.
The VA OIG report regarding intent to file concluded that
VBA staff did not always assign correct effective dates for
compensation. The VA led the entire initiative and set the
deadlines well before publishing a proposed and final rule.
Time constraints and any subsequent minimally viable product
during this period was self-imposed. The VA must address
processing issues associated with the intent to file to avoid
additional costs and inconvenience to veterans and their
families. VA claims must be processed accurately. Veterans
should not experience additional harm in the process,
especially when processing MST-related claims.
The improper denial of nearly half the MST-related claims
submitted to the VA is unacceptable. Finding ways to ensure
these veterans receive the services they deserve is one of the
highest priorities of the American Legion. VBA should review
all MST-related PTSD decisions since 2011 and share the results
with Congress and VSOs to ensure accuracy, transparency, and
accountability.
The growing diversity of veterans mean that a system which
primarily provided care to male enrollees must now evolve and
adapt to meet the needs of all veterans and to provide them the
best possible care. The VA must continue to adjust to the
changing demands of the population it serves.
The American Legion continues to work directly with
veterans to help them overcome challenges associated with
access to VA health care and claims process. We remain
committed to a VA that is appropriately funded, staffed,
trained, and empowered to conduct internal quality reviews and
oversight.
Chairman Bost, Ranking Member Esty, and distinguished
Members of this Subcommittee, thank you for the opportunity to
share the American Legion's position on these vital issues
impacting the men and women who have selflessly defended this
Nation. This concludes my remarks, and I look forward to
answering any questions you may have.
[The prepared statement of Greg Nembhard appears in the
Appendix]
Mr. Bost. Thank you.
So we are going to go to the 5 minutes of questioning. And
I am going to start out.
Mr. Liermann, we are going to start with you. And this is
probably the most simple, straightforward question, but
probably a very difficult one to answer, but do it anyway. How
about that?
Do you have any recommendations for how the VA can improve
how it develops and implements new policies and initiatives?
Mr. Liermann. Yes, Mr. Chairman, we do. And I think one of
the basic recommendations is to get everybody involved, whether
it is upstream, downstream, within the VA system, make sure all
the offices are touching each other and being aware of the
changes that are being made.
For example, what happened with the MST-related claims?
When they decided to put them in the National Work Queue, I
don't know if everybody was fully aware we lost specialization.
And prior to that in 2015, they stopped doing the special focus
review or quality review of those claims. So both of those
things happened, which created the problem we are currently in.
So it is like those decisions were made in a vacuum.
What we need to do is bring everybody in together and
discuss how these are going to touch, as well as VSOs. And I
really believe RVSRs and VSRs should be a part of these
conversations because they are the ones dealing with this work
on the local level. So they truly understand what changes will
impact them and the choices or decisions they make.
So I think if we are able to get everybody together, maybe
not in a formal setting, but be able to vet these things up and
down with everybody involved so we can see some of these
possible unintended consequences in the future and prevent
these types of things from happening.
Mr. Bost. Mr. Figlioli, do you have anything to add to that
that you might suggest?
Mr. Figlioli. Thank you, Mr. Chairman. No, I can only
concur with my colleague. It is something that we have brought
up to the VBA, BAS, the VA a number of times. Get everybody in
the room, listen to all of our experienced opinions. We are
their partners.
I had to commend Dr. Lawrence, since he has been the new
Under Secretary and being a bit more open and more inclusive,
we see progress. But I concur with my colleague.
Mr. Bost. Mr. Nembhard?
Mr. Nembhard. Thank you, Mr. Chairman. I have to agree with
my colleagues here, and I want to second Mr. Figlioli's
comments about Dr. Lawrence bringing us to the table.
We have seen an increase in communication and in meetings
with the VBA, and we truly appreciate that. I think that is the
way forward, and we hope that relationship continues to build.
Mr. Bost. All right. That kind of springboards me into the
other question that I have got for each one of you. Can you
describe the extent to which your organization consulted prior
to introduction of the NWQ and your organizations' suggestions
and incorporated the rollout?
Mr. Liermann. Thank you, Mr. Chairman. I guess when the
National Work Queue was rolled out, I am not aware of any
consultation that was specifically done across-the-board before
it was rolled out. I think it was brought to us once it was
closer to a test subject and already being tested and piloted.
I guess what we would have liked to have pointed out at
that time is to make sure that anything that is specialized can
still be specialized within the system, because by removing
that, it really has created a lot of the problems, not only
with the MST but the ALS.
Mr. Bost. So what you are saying when I asked were you
consulted before, you were not consulted or talked to until it
was already rolled out?
Mr. Liermann. Well, Mr. Chairman, that happened before I
was on our legislative staff.
Mr. Bost. Okay.
Mr. Liermann. So to answer that confidently, I am not sure.
But I am not fully aware that we were. We may have been. I
would have to discuss that with our service department.
Mr. Bost. Does the VFW or the American Legion, either of
you know whether you were?
Mr. Nembhard. Well, I was not in this position at the time,
Mr. Chairman, but I can get you a more accurate answer to that
after this session.
Mr. Figlioli. Mr. Chairman, thank you. I too was not in
this position at the time National Work Queue was developed. I
can only add to that that we did, after the fact, bring our
concerns to the VA. There had been improvements made, but at
the end of the day, we still have lost local advocacy through
the system.
Mr. Bost. Thank you. And I yield back.
And, Ms. Esty, you are recognized for 5 minutes.
Ms. Esty. Thank you very much. I want to thank the under
secretary and his team for staying. It is really important that
you are here to hear from the VSOs. And I think that--I want
that on the record and I want that noted, because I think that
is exactly what the three of you gentlemen are talking about,
the importance of collaboration, of understanding we are all
partners in doing better for veterans. And this is precisely
what we always need to be doing.
And I think what you noted about, and I was pleased, I will
also note that all three of you concurred with the Under
Secretary's assessment that appeals modernization is proceeding
with that kind of input from the beginning. And I think that
needs to be baked in as what is standard operating procedure.
I also want to note, because I know from my conversation
with the Under Secretary yesterday, to underscore the
importance of what you do as VSOs.
We discussed yesterday, he talked to me about how he had
reviewed our hearing about the sort of notices veterans receive
and the unintelligible language that leads to lots of questions
and lots of appeals. A great deal of work by VSO officers. He
said he looked at that tape and has begun a complete overhaul
of those letters.
So I think that speaks a lot to the importance of our
collective efforts and our collaboration, whether it is Members
of Congress, members of the public, VSOs, those at the VA, to
genuinely find a better way forward to serve the veterans
community. And I think we need to keep those lines of
communication open. Accountability is, of course, important,
but the main mission is really to do it better and get it right
the first time.
What I hear all three of you talking about is, in fact,
what we have seen, which is by taking--and Under Secretary
acknowledged, by focusing so much, I think, on the National
Work Queue and that backlog and the timeliness issue, the eye
got taken off of quality. Quality has to be there. And so your
input as these processes move forward to make sure we pick back
up specialization.
Mr. Figlioli, you mentioned something that has been, I
think, much on our mind is how we utilize the benefits of the
National Work Queue but don't have the siloing and don't have
the delay that happens when you can't resolve claims within a
single regional office. Could you expand on that a little bit?
Given that we have the National Work Queue in place now,
how can you imagine--you mentioned empowering, you know, the
ability to decide issues closer to that granular level. Can you
talk about what you have seen or concepts you have or how we
can try to better integrate the best of both worlds, right,
that granular concentration in one office, yet the efficiency
of having National Work Queue?
Mr. Figlioli. Thank you, Ranking Member. It has been a
concern for a while. I think my colleagues would also agree.
Before National Work Queue, you sat face-to-face with a
veteran, you heard their story, you heard their concerns, you
built a relationship with them. You knew the people in the
regional office and you were able to have conversations as that
claim went through the system.
As National Work Queue has been implemented, the claim may
start off in Boston, it will go to New York, it can be out into
the Philippines, all in the same day. And at some point, that
local advocate has lost eyes on what that claim is.
Suddenly, we are asking a VSO that is in Houston, who had
no input in the beginning of the session or the process, to
review a claim and alert the VA to what is good, bad, or
indifferent about that claim but not know the personal touch of
that veteran or that veteran's personal story.
Then the other process is going back to get these things
corrected, essentially moved across the country. We no longer
had the ability to just, you know, get in the elevator and go
downstairs and talk to somebody. We have to send things via
email or via a phone call to several regional offices. And by
the time you get caught up with it, it could be moved somewhere
else. It is highly inefficient, and it is just a shame that we
have lost that ability to get things resolved at the lowest
possible level before they end up in appeals.
Ms. Esty. Anyone else has thoughts on this? This is going
to be an ongoing issue, I think, about how to get the
efficiency of those medical records, electronic medical records
and processing of claims, specialization, but also that
personal touch.
So again, I want to thank you as we move forward in this
Committee, over in the Senate, with our colleagues at the VA,
how to do a better job and, again, try to get the best of that
efficiency with the quality, the timeliness, and that human
touch, you know, the hands-on that the VSOs have always
provided and I think need to provide.
We should not expect our veterans to be experts in appeals
law, Veterans Affairs regulations. That is not their job. It is
our job to take care of them.
So, again, I want to thank all of you for joining us here
today. And I want to thank the Chairman for his ongoing efforts
and all of you to do better for our veterans.
Thank you.
Mr. Bost. I want to thank everyone for being here. With
that, I want to recognize the Ranking Member if she has--for
any closing remarks she might want to make besides what she--
Ms. Esty. I think this is going to be my last Subcommittee
hearing in Congress on this with this really wonderful
Committee. And I want to thank all of you for your partnership,
your hard work. And I am strongly urging this big new class of
freshmen Members of Congress, whether they serve on this
Committee or not, to honor that commitment to our Nation's
veterans.
And, Mr. Nembhard, you mentioned a really important issue
about the diversity that we see of our veterans now. And we
need to keep our eye on that moving forward. We have a very
diverse group of veterans we are serving now. World War II
veterans who have certain life experience, certain way they
want to interface with the VA, and we have got brand new
veterans coming out, who are unprecedented numbers of women,
much younger, much different backgrounds.
And that is a challenge for all of us, but I hope we are
all up to the challenge. And I hope the 116th Congress and this
Committee will continue to do its best to be honest brokers and
partners in doing better for our Nation's veterans.
And I want to thank the Chairman and the excellent staff on
this Committee for their hard work and their bipartisan
cooperation to make sure that we are all, to the best possible,
rowing in the same direction and doing our level best every day
for our Nation's veterans.
Thank you all, and I yield back.
Mr. Bost. Thank you.
And before we do adjourn, let me say this: It has been one
of the greatest honors that you could ever imagine being
Chairman of this Committee. And let me tell you that what we do
as far as our veterans, those living and those passed, through
this Committee is very humbling to work on this Committee.
Being Chairman of the Subcommittee, I will tell you, I
couldn't ask for--I want to thank Ms. Esty. We were able to
work together in a bipartisan manner when quite often in
Congress, the bipartisanship doesn't occur as often as it
should.
I also want to say a special thank you to the staff. The
staff has been wonderful, both Republican and Democrat staff,
hardworking. And it is the mission and our mission to make sure
our veterans are taken care of.
And know this, as a marine--and I will continue to serve in
Congress. I will still continue to focus on our veterans'
issues. And I thank the American people and the people that
voted in my district that gave me this opportunity. And thank
you to Chairman Roe for giving me the opportunity to be
Chairman of this Subcommittee.
So finally, as I said earlier--oh, hold on. Ah, and also to
ways to improve with the Department and assist any way we can.
So with that, I am going to say as I did earlier, complete,
written statements for today's witnesses will be entered into
the hearing record. I ask for unanimous consent that all
Members have 5 legislative days to revise and extend their
remarks and include extraneous material.
Hearing no objection, so ordered.
This hearing is now adjourned.
[Whereupon, at 1:17 p.m., the Subcommittee was adjourned.]
A P P E N D I X
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Prepared Statement of Dr. Paul R. Lawrence
VETERANS BENEFITS ADMINISTRATION (VBA)
Good morning, Chairman Bost, Ranking Member Esty, and Members of
the Committee. Thank you for the invitation to speak today on VBA's
methods for developing and implementing policy changes and initiatives.
Joining me today is
Mr. Willie Clark, Deputy Under Secretary for Field Operations and
Ms. Beth Murphy, Executive Director of Compensation Service. In this
statement, I will provide an overview of how VBA develops, implements,
and manages change within the organization. I will highlight some key
initiatives and progress from recent internal reviews and will discuss
strategies to enhance the effectiveness of our programs.
Developing Collaborative Initiatives
VBA's number one priority is to provide Veterans with the benefits
they have earned in a manner that honors their service. While doing so,
VBA also focuses on ensuring we are strong fiscal stewards of the money
entrusted to us and fostering a culture of collaboration. These
principles guide our modernization efforts and our approach to
organizational changes and improvements.
VBA is a learning organization that embraces oversight and
continually seeks to improve the business of serving Veterans and their
families. VBA manages a wide range of Veterans' benefits and programs-
governed by laws, regulations, and procedures-administered across 56
regional offices (RO). VBA operates in a dynamic community uniquely
positioned to identify existing challenges and propose new solutions to
improve the benefits claims process and its outcomes. This community
includes key stakeholders such as Veterans, VA employees, Congress,
Veterans Service Organizations (VSO), and other Veterans'
representatives.
VBA welcomes the oversight role of Congress and other entities,
such as VA's Office of Inspector General (OIG) and the Government
Accountability Office (GAO), to identify areas for improvement and
change. VBA's partnership with VSOs also helps identify the needs and
concerns of Veterans and gather ideas for policy and operational
changes while leveraging external resources.
VBA also relies on its employees for input on operational and
procedural innovations. Annual leadership training events are critical
forums for the exchange of ideas between field and VA Central Office
(VACO) leaders. Recurring training, quality, and collaboration calls
between VACO and ROs are vital in sharing information and gathering
suggestions for change.
Implementing Change and Achieving Results
VBA has transformed and modernized its claims processing activities
dramatically over the past several years, primarily by becoming an
organization that operates in a paperless, electronic claims processing
environment for a significant portion of its work, which allows us to
more efficiently and effectively assess and manage workload.
We have previously shared information about our successes with the
National Work Queue, our automated workload prioritization and
distribution tool that enables VBA to maximize the capacity of claims
processors nationally. The National Work Queue has contributed to more
efficient claims processing; for example, during the last fiscal year,
76 percent of disability rating claims were completed within 125 days,
a 10 percent improvement over 2017. Also in 2018, VBA began
distributing non-rating claims using the National Work Queue, reducing
inventory by 31 percent and improving timeliness by 36 percent over
2017 production levels. In Fiscal Year (FY) 2017 and FY 2018, data-
driven employee performance standards were developed to better match
the NWQ environment. Employee performance standards continue to be
monitored as changes occur to ensure they are fair and obtainable while
still maximizing productivity.
Similarly, in October 2017, Compensation Service launched the
Quality Management System (QMS) that utilizes a national approach to
automating and routing individual quality reviews and corrections for
employees. QMS was created using a customized commercial off-the-shelf
product, which allowed VBA to leverage the usage of existing products.
Today, more than 10,000 VBA field employees across the 56 ROs use QMS
to manage error corrections, with nearly 700,000 cases reviewed to date
in QMS. Overall, QMS has allowed quicker reviews, more timely
corrections, and fairness in the review process to help lead to a
higher quality product delivered to veterans. VBA remains focused on
mitigating performance risks by improving training, and providing a
faster quality feedback loop on completed work. Such efforts are
reflected in a positive quality trend in the past fiscal year across
rating and authorization accuracy measures.
Another milestone in VBA's paperless efforts was achieved in
September 2018, when the last paper records exited the Records
Management Center (RMC) in St. Louis, Missouri. This is the culmination
of a multi-year plan to extract and scan all claims folders and service
treatment records from the 56 ROs and RMC. The goal behind this
extraction was to make Veterans' records instantaneously available
electronically in the Veterans Benefits Management System (VBMS) for
faster claims processing. In all, more than 7.8 million inactive paper
claims records have been extracted for scanning. Some of the space in
RO's previously designated to store files has been reallocated to
support initiatives such as Appeals Modernization.
In FY 2018, VBA updated systems, policies, and data matching
agreements to develop a more streamlined and efficient audit process to
certify continued entitlement to the Individual Unemployability (IU)
benefit. IU payments are provided to Veterans who are unable to follow
a substantially gainful occupation due to service-connected disability.
Instead of manually mailing annual income certification forms to all
Veterans in receipt of IU, VBA now sends forms only to those Veterans
with incomes above the eligibility threshold, based on its existing
automated data match with the Social Security Administration. In
September 2018, VBA sent a paper copy of the certification form to
fewer than 10 percent (only 3,163 out of 368,979) of IU recipients
compared to prior years because of the data match capability. This
process strengthens internal controls, reduces burdens on Veterans, and
redirects over 300,000 staff hours annually to processing other types
of claims.
These are examples of VBA's continuous improvement efforts to serve
Veterans and their families. In each instance, VBA identified
procedural or operational opportunities. These opportunities were then
discussed, planned, and executed with key partners or industry experts.
Options were tested and risks were identified and mitigated while
keeping actively engaged in change management, training, and
communications to ensure improved outcomes.
Recent Inspector General Reports and VBA Actions to Address Report
Recommendations
In addition to internally-driven improvements, VBA also
incorporates recommendations from oversight organizations, such as GAO
and OIG. I will briefly address three recent OIG reports and subsequent
VBA actions taken in response to these reports.
Military Sexual Trauma (MST) - OIG conducted a review of VA's
processing of Posttraumatic Stress Disorder (PTSD) claims related to
MST. VBA concurred with OIG's findings of inadequate processing of
these sensitive issue claims and has taken immediate steps to implement
the recommendations, which include a special claims review. VBA issued
guidance to its ROs on the processing of MST-related claims and
continues to emphasize the importance of training and appropriate
processing of these claims on national calls with the field.
Recommendations included updating training and development checklists
for MST-related claims at the end of FY 2018. The checklists and the
first training course focused on development and identification of
markers and were implemented at the end of September 2018. By October
2nd, 2018, VBA provided updated training and guidance to claims
processors. Additionally, VBA developed an action plan that has us on
track to conduct special focus reviews and consistency studies in a
timely manner. VBA has plans to designate specialized groups of trained
Veterans Service Representatives and Rating Veterans Service
Representatives to process MST-related claims by the end of November.
These specially-trained employees will maintain proficiency by working
MST claims on a regular basis.
Intent to File (ITF) - The purpose of this OIG review was to
determine whether VBA staff assigned correct effective dates on claims
for compensation benefits with an ITF, which is an effective date
placeholder in lieu of the previous ``informal claim.'' OIG found
errors in VBA's assignment of effective dates but acknowledged
improvement in ITF effective date quality over time as VBA implemented
a variety of training products and system enhancements. Specifically,
VA modified its procedures in July 2016 to include guidance and
specific details on how to identify ITFs received electronically or by
mail. In June 2017, VA updated VBMS to create a banner to remind staff
that an ITF exists. The most recent accuracy reviews reflect an error
rate of less than 4 percent, down from 44 percent. VBA will continue to
monitor the quality of ITF effective dates to include determining if
additional VBMS functionality is needed.
Reexaminations - OIG conducted this review to determine whether VBA
employees required Veterans to undergo unwarranted reexaminations. VBA
agreed with OIG recommendations to establish better internal controls,
design system automation features, and enhance quality assurance
reviews to minimize unwarranted reexaminations. Prior to the audit, VBA
had already initiated process improvements to address reexaminations,
including a FY 2017 data-mining initiative that removed 44,000 marked
claims which were determined to be unnecessary, saving exam costs and
reducing the burden on Veterans. OIG's audit reinforced this
initiative, and in FY 2018, VBA conducted Phase 2 of this initiative by
removing another 32,000 claims designated for reexamination. VA will
continue to utilize six-month periodic reviews of data and will
implement new updates to our rules in VBMS in FY 2020. In October 2018,
VA also updated its National Quality Review checklist to ensure
employees are correctly requesting reexaminations.
Looking Ahead
In fulfilling the mission to deliver timely and high-quality
benefits and services, VBA serves as a leading advocate for Veterans,
Servicemembers, and their families. A few important components of how
VBA will mitigate risk and maximize our effectiveness in this role will
be highlighted.
VBA is committed to continuously increasing collaborative efforts
internally and externally. VBA currently holds monthly meetings with
OIG and has begun similar recurring meetings with GAO. In addition to
these collaborative sessions, VBA and the acting Chief Information
Officer along with their teams meet regularly in person to track key
information and status of technology projects. Supportive of these
engagement sessions, we continue to embrace VBA's longstanding practice
of engaging VSOs in several monthly and quarterly forums to share
information, listen, and engage them as project partners and strong
Veteran advocates.
Conclusion
In conclusion, VBA develops and executes change initiatives with
input from a myriad of sources both within and outside of VA. VBA
continues to incorporate technology and process improvements while
embracing oversight and accountability, which are beneficial to
improving our level of service and ensure good stewardship of taxpayer
dollars. At the heart of VBA's strategy to manage change is our focus
on assisting and serving Veterans and their families.
VBA is focused on continuous, deliberative, and collaborative
improvement by fostering relationships in place and further developing
our planning processes. In doing so, VBA continues to strive for
excellence in the service and products it provides to our Veterans.
This concludes my testimony. I would be happy to address any
questions from you and other Members of the Committee.
Prepared Statement of Michael J. Missal
INSPECTOR GENERAL
Chairman Bost, Ranking Member Esty, and members of the
Subcommittee, thank you for the opportunity to discuss the Office of
Inspector General's (OIG's) oversight of the programs and operations of
the Veterans Benefits Administration (VBA). We recently made changes to
our oversight model for VBA to allow us to better review national
policy changes and focus on their high-impact programs and operations.
Aside from reporting on specific problems and providing targeted
solutions to VBA, we have emphasized identifying the underlying root
causes of issues that have negatively impacted current programs and
future initiatives. Among other causes, we have identified program
leadership and governance as common deficiencies. We are committed to
uncovering the source of problems that put taxpayer dollars and
veterans' benefits at risk of fraud, waste, and abuse or that undercut
the quality and timeliness of services to veterans and their families.
We believe that recent VBA initiatives and policy changes were
well-intentioned to expedite the benefits process. Our recent reviews
and audits, however, have revealed that VBA's emphasis on efficiency
has affected its ability to review and process claims accurately. Our
reports identified recurring deficiencies, such as the lack of adequate
controls and information technology functionality, that resulted in the
inefficient delivery of services and inaccurate benefits rendered to
veterans.
Background
The OIG is committed to conducting effective oversight of VA
programs and operations through independent audits, inspections,
reviews, and investigations. VBA is responsible for delivering
approximately $100 billion in federally authorized benefits and
services to eligible veterans, their dependents, and survivors.
In October 2017, the OIG implemented a new national inspection
model for VBA oversight. Previously, the OIG largely conducted
oversight through inspections of VBA's 56 regional offices. Under the
new model, the OIG now conducts nationwide audits and reviews of high-
impact programs and operations within VBA. The purpose of these audits
and reviews is to
Identify systemic issues within VBA that affect veterans'
benefits and services,
Determine the root causes of identified problems, and
Make useful recommendations to drive positive change
across VBA.
Since October 1, 2017, the OIG has published 15 oversight reports
related to VBA. \1\ In these reports, the OIG made 55 recommendations
to VBA for improvement, \2\ and identified nearly $278 million in
potential monetary benefits. VBA has generally concurred with our
recommendations and provided acceptable action plans. It must now
follow through with the difficult work of implementation if they are to
carry out their responsibilities effectively and be good stewards of
taxpayer dollars.
---------------------------------------------------------------------------
\1\ Audit of VBA's National Pension Call Center, November 1, 2017;
Review of Claims Processing Actions at Pension Management Centers,
November 1, 2017; Review of Alleged Appeals Data Manipulation at the VA
Regional Office, Roanoke, VA, December 5, 2017; Audit of Vocational
Rehabilitation and Employment Program Subsistence Allowance Payments,
March 15, 2018; Review of Timeliness of the Appeals Process, March 28,
2018; Alleged Contracting and Appropriation Irregularities at the
Office of Transition, Employment, and Economic Impact, May 2, 2018;
VA's Compliance with the Improper Payments Elimination and Recovery Act
for FY 2017, May 15, 2018; Unwarranted Medical Reexaminations for
Disability Benefits, July 17, 2018; Denied Posttraumatic Stress
Disorder Claims Related to Military Sexual Trauma, August 21, 2018;
Processing Inaccuracies Involving Veterans' Intent to File Submissions
for Benefits, August 21, 2018; Accuracy of Effective Dates for Reduced
Evaluations Needed Improvement, August 29, 2018; VA Policy for
Administering Traumatic Brain Injury Examinations, September 10, 2018;
Review of Accuracy of Reported Pending Disability Claims Backlog
Statistics, September 10, 2018; Timeliness of Final Competency
Determinations, September 28, 2018; Accuracy of Claims Involving
Service-Connected Amyotrophic Lateral Sclerosis, November 20, 2018.
\2\ As of November 19, 2018, 35 of the 55 recommendations (64
percent) remain open/not fully implemented.
---------------------------------------------------------------------------
Recent OIG Oversight Reports
We want to highlight four recently-issued reports related to the
OIG's oversight of VBA that we believe are illustrative of our efforts:
Unwarranted Medical Reexaminations for Disability
Benefits
Denied PTSD Claims Related to Military Sexual Trauma
Processing Inaccuracies Involving Veterans' Intent to
File Submissions for Benefits
Accuracy of Claims Involving Service-Connected
Amyotrophic Lateral Sclerosis (ALS)
In these four reports, the OIG made a total of 14 recommendations
to the Under Secretary for Benefits and identified about $187 million
in potential monetary benefits. The reports' findings identify a number
of systemic problems that VBA needs to address:
Deficient control activities
Inadequate program leadership and monitoring
Lack of information technology system functionality
Unintended impacts of the National Work Queue
Unwarranted Medical Reexaminations
The OIG conducted a nationwide review to determine whether VBA
staff required veterans with disabilities to be subjected to
unwarranted medical reexaminations. According to VBA policy, medical
reexaminations can be requested when there is no qualified exclusion
from reexamination. A qualified exclusion could include, for example, a
disability that is permanent and not likely to improve, a disability
without substantial improvement over five years, and updated medical
evidence in the claims folder sufficient to continue the current
disability evaluation without additional examination. If not subject to
exclusion, reexaminations may be requested when there is a need to
verify the continued existence, or current severity, of a disability.
VBA policy also requires staff to exercise prudent judgment in
determining the need for reexaminations by requesting them only when
necessary and making every effort to limit those requests.
The OIG reviewed a statistical sample of 300 cases with
reexaminations from March through August 2017 and found that VBA staff
requested unwarranted medical reexaminations in 111 cases. Based on
this sample, the OIG estimated that VBA staff requested unwarranted
reexaminations in 19,800 of 53,500 cases. As a result, the OIG
projected that VBA spent about $10.1 million on these unwarranted
reexaminations. The OIG further estimated that VBA would waste an
additional $100.6 million over the next five years unless it ensures
that staff only request medical reexaminations when necessary. The OIG
made four recommendations for
(1) establishing internal controls to ensure that a reexamination
is necessary, (2) prioritizing the design and implementation of system
automation to minimize unwarranted reexaminations,
(3) enhancing VBA's quality assurance reviews of requested
reexaminations, and (4) conducting a focused quality improvement review
of cases with unwarranted reexaminations to understand and redress the
causes of avoidable errors. The Under Secretary for Benefits concurred
with the recommendations and provided acceptable action plans.
Denied Military Sexual Trauma-Related Claims
The OIG conducted a nationwide review to determine whether VBA
staff correctly processed claims related to veterans' military sexual
trauma (MST) in accordance with VBA procedures prior to denying the
claims. Some service members are understandably reluctant to submit a
report of MST, particularly when the perpetrator is a superior officer.
Service members may also have concerns about the potential for negative
performance reports or punishment for collateral misconduct. There is
also sometimes the perception of an unresponsive military chain of
command. If the MST leads to posttraumatic stress disorder (PTSD), it
is often difficult for victims to produce evidence to support the
occurrence of the assault. VBA policy, therefore, requires staff to
follow additional steps for processing MST-related claims so veterans
have additional opportunities to provide adequate evidence.
VBA reported that it processed approximately 12,000 claims per year
over the last three years for PTSD related to MST. In fiscal year 2017,
VBA denied about 5,500 of those claims (46 percent). The review team
assessed a sample of 169 MST-related claims that VBA staff denied from
April through September 2017. The review team found that VBA staff did
not properly process veterans' denied MST-related claims in 82 of 169
cases. As a result, the OIG estimated that VBA staff incorrectly
processed approximately 1,300 of the 2,700 MST-related claims denied
during that time (49 percent).
The OIG made six recommendations to the Under Secretary for
Benefits including that VBA review all approximately 5,500 MST-related
claims denied from October 2016 through September 2017, take corrective
action on those claims in which VBA staff did not follow all required
steps, assign MST-related claims to a specialized group of claims
processors, and improve oversight and training on addressing MST-
related claims. The Under Secretary concurred with the recommendations
and has already taken steps to address them. The Under Secretary
recently stated that VBA was increasing its focus on MST claims by
updating required training for claims processors, as well as adding
more quality and accuracy reviews of MST claims. The Under Secretary
also stated that, in FY 2019, VBA will review every denied MST-related
claim decided since the beginning of FY 2017.
Intent to File Submissions
The OIG conducted a nationwide review to determine whether VBA
staff assigned correct effective dates for compensation benefits with
submissions of an intent to file (ITF). Before March 24, 2015, VBA
could grant entitlement to benefits as early as the date of receipt of
an informal claim as long as a formal claim was submitted within one
year of the date VBA sent the claimant the application form. However,
to standardize its claims process, VBA removed the informal claims from
its regulations and replaced them with the ITF process. With the new
process, claimants can submit an ITF electronically, by mail, or by
calling a VBA representative. The submission date of an ITF is
important because VBA may use the ITF's date of receipt as the
effective date for paying benefits.
From March 24, 2015, through September 30, 2017, VBA reported
receiving more than 1 million claims using ITF submissions. The OIG
reviewed a statistical sample of 300 claims with ITF submissions during
this period and found that VBA staff incorrectly assigned effective
dates in 56 cases. Based on this sample, the OIG estimated that 22,600
of the 137,000 cases (17 percent) completed during this period had
incorrect effective dates assigned. The OIG estimated that these errors
resulted in an estimated $72.5 million in inaccurate benefits payments
to veterans-of which about 97 percent were underpayments. Most of the
errors occurred during the initial period of ITF implementation, and
the OIG found that VBA made significant improvements over time. VBA has
since reduced the number of incorrectly dated claims to 4 percent. The
OIG recommended that the Under Secretary for Benefits prioritize the
modernization of the ITF system and consider integrating ITF
submissions into the Veterans Benefits Management System (VBMS), VBA's
electronic claims processing system. The OIG also recommended a special
review of veterans' claims with ITFs submitted during the initial
implementation period. The Under Secretary concurred with the
recommendations and provided acceptable plans for implementation.
Amyotrophic Lateral Sclerosis Claims
The OIG conducted a nationwide review to determine whether VBA
accurately decided veterans' claims involving service-connected
Amyotrophic Lateral Sclerosis (ALS). VA describes ALS, commonly
referred to as Lou Gehrig's disease, as a rapidly progressive
neurological disease that attacks the nerve cells responsible for
directly controlling voluntary muscles. Because a statistical
correlation was found between military service activities and the
development of ALS, VA established a presumption of service-connection
in 2008. As a result, veterans who develop the disease during service,
or any time after separation from military service, generally receive
benefits if they had active and continuous service of 90 days or more.
Although VBA prioritizes claims for veterans with ALS, staff must also
accurately decide these claims because it is a serious condition that
often causes death within three to five years from the onset of
symptoms.
The OIG reviewed a statistical sample of 100 veterans' case
involving service-connected ALS from April 2017 through September 2017.
The team found that VBA staff made 71 errors involving 45 veterans' ALS
claims. We then projected that 430 of 960 total ALS veterans' cases had
erroneous decisions.
For example, rating personnel incorrectly decided ALS claims
related to one or more of the following categories:
special monthly compensation benefits
evaluations of medical complications of ALS
effective dates
benefits related to adapted housing or automobiles
inaccurate or conflicting information in decisions
proposals to discontinue service-connection
These errors resulted in estimated underpayments of about $750,000
and overpayments of about $649,000 over a six-month period. The OIG
estimated that VBA could make an estimated $7.5 million in
underpayments and $6.5 million in overpayments over a five year period
if VBA staff continue to make errors at the rate identified in this
review. Also, VBA staff generally did not tell veterans about special
monthly compensation benefits that may be available. The Under
Secretary for Benefits agreed to implement the OIG's two
recommendations to implement a plan to improve and monitor decisions
involving service-connected ALS and to provide notice regarding
additional special monthly compensation benefits that may be available.
Systemic Issues
Within just these four reports, the OIG identified common systemic
issues that contributed to the troubling outcomes detailed in their
findings. As mentioned earlier, these include deficient control
activities, inadequate program leadership and monitoring, a lack of
information technology system functionality, and the unintended impacts
of VBA's National Work Queue implementation.
Deficient Control Activities
The Comptroller General is required by the United States Code to
issue standards for internal control in the federal government. \3\ The
Government Accountability Office (GAO) Standards for Internal Control
in the Federal Government provides the overall framework for
establishing and maintaining an effective internal control system. It
further defines control activities as the actions that management
establishes through policies and procedures to achieve objectives. In
all four reviews, the OIG determined that inadequate control activities
contributed to the deficiencies identified.
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\3\ Section 3512 (c) and (d) of Title 31.
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VBA currently requires an additional level of review for some types
of complex claims, such as traumatic brain injury cases, but does not
require this additional level of review for MST-related claims. The OIG
determined that an additional level of review for MST-related claims
would serve as a control activity to ensure VBA staff processes claims
in accordance with applicable regulations.
We reported in our ALS work that VBA policy requires an additional
level of review for decisions involving higher levels of special
monthly compensation. The OIG identified errors in 25 ALS decisions
despite having additional reviews by rating personnel or VA regional
office managers. The OIG determined VBA should implement a plan to
improve the decisions and additional reviews of claims involving ALS
and monitor these claims to ensure staff demonstrate proficiency.
In the ITF review, errors generally occurred because the ITF
process was new and had a six-month implementation and delivery period.
VBA did not take the time to set up adequate standard operating
procedures before implementing the new initiative. The OIG determined
that errors generally occurred due to inadequate procedural guidance
that lacked specific details for locating electronic ITF submissions
within VBMS. Since nationwide implementation of the ITF process, VBA
has taken steps to improve its control activities, which has resulted
in improved accuracy.
We found in the unwarranted reexaminations review that VBA policy
requires a pre-exam review of the veteran's claims folder before
requesting that a veteran appear for a medical reexamination to
determine whether it is needed. The pre-exam review should be completed
by a rating veterans service representative and would serve as a
control activity to prevent unwarranted reexaminations. However, VBA
management routinely bypassed the pre-exam review, which contributed to
the significant number of unwarranted reexaminations ordered by VBA
staff.
Inadequate Program Leadership and Monitoring
One of the key requirements set forth by federal internal control
standards is program monitoring. Management should establish and
operate activities to monitor the internal control system and evaluate
needs, as well as remediate identified internal control deficiencies in
a timely manner. In two of the four reviews, the OIG determined that
inadequate program monitoring was a contributing factor to the problems
identified.
VBA's quality assurance programs consist of the Systematic
Technical Accuracy Review (STAR) team nationally and the Quality Review
Teams (QRT) at each VA regional office. During the MST review, the OIG
determined that the STAR team stopped conducting special focused
quality improvement reviews of MST-related claims in December 2015. VBA
managers stated that they reallocated resources toward other areas
because the error rate declined for MST-related claims from 2011 to
2015. However, since the volume of MST-related claims is less than
other types of claims, many of these claims do not appear in the
typical samples reviewed by STAR and QRT staff, who therefore lacked
proficiency. The OIG concluded, and VBA agreed, that special focused
reviews should be reinstated and targeted feedback and training
provided to claims processors.
In the unwarranted reexaminations review, the OIG determined that
VBA's quality assurance processes did not measure whether VBA employees
requested reexaminations only when necessary. VBA also stated that the
quality assurance division had not conducted any trend analysis or
special focused quality improvement reviews of the reexamination
process. VBA agreed with the need for modifying the quality review
processes to include a review of reexaminations and with conducting a
special focused quality improvement review in this area.
Lack of Information Technology System Functionality
The OIG identified issues that can be traced to a lack of
information technology system functionality. For example, VBA could add
features to VBMS to prevent scheduling reexaminations in cases that
meet the exemption criteria. Specifically, VBMS could issue an alert if
a claims processor tries to request a reexamination for a veteran that
meets exception criteria. Implementing this strategy would help prevent
errors and reinforce training by providing immediate feedback to staff.
VBMS contains ITF data; however, the system lacked the
functionality to assist rating personnel when assigning effective dates
for benefits based on ITFs. More than two years after the
implementation of ITF, in June 2017, VBA updated VBMS. Additional
modernization of functionality within VBMS could further improve
accuracy of assigning effective dates related to ITF submissions. The
OIG recommended that VBA prioritize the design and implementation of
system automation reasonably designed to minimize these issues.
Unintended Impact of National Work Queue
VBA's National Work Queue (NWQ) distributes claims daily to each VA
regional office based on factors such as workload capacity, national
claims processing priorities, and special missions. While the NWQ is
designed to create efficiencies, it has created other unintended
consequences. In 2016, when VBA implemented the NWQ, it no longer
required VA regional offices to use specialized staff to process claims
that VBA designated as requiring special handling, which included MST-
related claims. As a result, all claims processors became responsible
for a wide variety of claims, including MST-related claims. However,
many claims processors did not have the experience or expertise to
process these types of claims. This was a contributing factor to VBA
staff incorrectly processing almost half of veterans denied MST-related
claims. The Under Secretary for Benefits has agreed to reinstate
specialized teams to process these claims.
Ongoing OIG Oversight
In addition to the recently completed oversight, the OIG continues
to work on matters designed to improve the delivery of benefits to
veterans and their families, including several ongoing nationwide
reviews to identify systems-level barriers to effective and efficient
implementation efforts.
For example, in August 2018, the OIG initiated a review related to
the Decision Ready Claims (DRC) program. VBA established the DRC
program to streamline claims processing and improve timeliness. Like
the ITF process, VBA prioritized the DRC program and implemented it
within about six months. VBA piloted the program in May 2017 and
implemented it nationally in September 2017. As of October 2018, VBA's
self-reported data shows that DRC cases have been completed in an
average of about 15 days. However, the number of claims submitted
through the program has fallen far short of what VBA initially
anticipated. As a result, the OIG initiated a review to determine
whether VBA effectively planned and implemented the program. The OIG
anticipates publishing the final report for this review in early 2019.
In May 2018, the OIG also initiated a review related to canceled
contract medical examinations. VBA requests Compensation and Pension
medical exams from a Veterans Health Administration (VHA) clinician, or
through one of the Medical Disability Examination contract vendors.
Exam cancellations can delay veterans' claims, waste appropriated
funds, and increase VBA's workload because they duplicate the exam
request process. Exam cancellations can also cause an adverse decision
on veterans' claims. The OIG anticipates publishing the final report
for this review in early 2019.
Conclusion
VBA attempts to quickly implement programs and policies and reduce
claims backlogs have resulted in unintended consequences. These include
sacrificing accuracy for timeliness, rolling out national initiatives
after small and short pilot programs, and other efforts to meet the
changing and growing demands for benefits and services. The OIG's
efforts to identify important systemic issues and focus on high-impact
programs and initiatives will help limit those unintended consequences,
and better position VBA to provide service to veterans and their
families in the most effective and efficient manner possible.
Mr. Chairman, this concludes my statement. I would be happy to
answer any questions you or other members of the Subcommittee may have.
Prepared Statement of Michael Figlioli
Chairman Bost, Ranking Member Esty, and members of the
Subcommittee, on behalf of the Veterans of Foreign Wars of the United
States (VFW) and its Auxiliary, thank you for the opportunity to
provide our comments on evaluating the Department of Veterans Affairs'
(VA) methods for developing and implementing policy changes.
As the VFW National Veterans Service (NVS), which was established
in 1919, begins its second century of service to our nation's veterans
and their families, the VFW is encouraged by VA's efforts to modernize
and update the disability claims process. We take into account a number
of challenges, both technical and administrative, that VA has had to
overcome to arrive where we are today. Yet, despite our support for
some changes and opposition to others, we feel the process is headed in
the right direction overall. Our philosophy in dealing with VA's
cumbrous bureaucracy has always been ``praise when you can, be critical
when you must'' if it is in the best interest of our veterans. Lately,
we have found ourselves more on the critical side than we would like.
The VFW has consistently held that VA speeding to completion of its
claims workload for the sake of reducing volume is precarious for both
VA and our claimants. It does no good to deliver benefits to veterans
faster if the decisions made are incomplete or inaccurate. It is futile
to implement policies for the sake of implementing policies and declare
mission accomplished. Often, employees are just becoming comfortable
with the former system only to be forced to employ a new system or
business process in the name of efficiency.
Over the last three years, VA has rolled out programs that in
theory were intended to alleviate a number of claims and appeals
related issues. The VFW and our partner veterans service organizations
(VSOs) cautioned VA on numerous occasions about the pitfalls of rapid
development. We are appreciative of VA's efforts in seeking VSO input
for newly developed platforms. Yet in the final analysis, despite our
repeated attempts urging VA to assess shortfalls and take corrective
action before programs went fully operational, we have seen VA forced
to play catch up time and time again.
The VFW has been concerned since the implementation of the Veterans
Benefits Administration's National Work Queue (NWQ), and other
programs, about how VA evaluates its workforce and products. Why do
some claims seem to move smoothly through the system while others are
bogged down due to misunderstood guidance or improper application of
the law? We have not discerned why, other than pointing to one
consistency: inconsistency in the system. We are well aware this is
going to take place, but up until the decision was made to ``level the
playing field'' we had the ability to mitigate irregularities at the
local level.
Since the implementation of NWQ, VSOs have been restricted more
than ever in locally resolving problems at the VA Regional Office
(VARO). In Pittsburgh, we worked through our local representative to
resolve a foreign claims issue, or so we thought. VA failed to properly
evaluate a claimed condition in 2015, pushing the veteran into a
lengthy appeal process that affected other subsequent claims. After
going through the normal protocols, the end result was that VA would
not correct the issue locally. However, our local advocate was
instructed that if we contacted the White House veterans' helpline, the
case would be given priority and the proper attention it should have
been given without the roadblocks.
In all my years as a VA-accredited veteran service officer, this is
one of the most absurd responses I have heard from VA staff on an issue
that could have been easily resolved. To be frank, the VFW has been
doing this work longer than VA. We pride ourselves in the advocacy we
can provide to our claimants. But what happens when VA no longer
permits its employees to do the right thing locally? I fear that the
drive to NWQ, while well intentioned, has only amplified problems with
VA inconsistency. The goal in leveling the playing field was to ensure
veterans received consistent, timely, quality decisions. The playing
field is certainly more level today, but not in the way we intended.
Instead, we see shoddy work from all corners of VA with little
accountability for what has gone wrong in the process. We see VARO
leadership that is hamstrung from doing the right thing because it may
make the national system look bad. This is no way to serve veterans.
As with any new implementation, training is paramount to success.
Unfortunately, this is a shortcoming in VBA on a number of levels.
Across the VFW's field offices, our staff continues to see little
consistency in the application of law or the Code of Federal
Regulations. The VFW is acutely aware of instances where the intent of
a regulatory change is crystal clear but applied irregularly at the
majority of VAROs.
One recent and ongoing example is the acceptance of electronic
signatures. VA transitioned claims submissions to an electronic format.
VSOs asked repeatedly if a ``wet signature'' was required or if an
electronic facsimile was acceptable. VBA Office of Field Operations
(OFO) advised us that a signature created on a VA-approved signature
pad would be acceptable, and we alerted our field staff. Despite our
best efforts to comply, we almost immediately began to receive reports
that claims were being rejected at certain VAROs due to veterans not
physically signing the form. Needlessly wasted time had to be taken
from claim processing for VACO to issue corrective guidance to those
offices that were in error, despite prior notification being sent to
the field and guidance being clearly published in the M21-1, the
standard operating procedure for adjudicating claims. Despite clear
guidance from VBA on this matter, we still receive sporadic reports
from the field that this has not been completely resolved. Similarly,
each time VA updates its standard claims forms, we receive reports that
VAROs immediately stop accepting the previous version both in paper and
electronic formats, even though this directly contradicts VA's own
rules allowing for continued use of recently expired forms. If VA is
earnest in seeking to establish a fully electronic claims process as
they have touted over the past few years, they need to ensure
consistency across the VAROs in allowing for electronic submissions.
Another instance of a breakdown in development and implementation
is dependency claims. This has been an issue for years, and one that
seems highly inconsistent. Some dependency claims move quickly through
rules-based processing. But there seems to be no consistency when a
dependency claim may be off-ramped, or even if a dependency claim will
be addressed in a timely manner. We cite an example regarding a veteran
living in Maryland whose claim was adjudicated through VA's NWQ across
several VAROs. The veteran meets the schedular requirements for
additional compensation for dependents. The VARO in Iowa denied his
claim based on a 21-686c that was filed with his original application
stating that he did not meet the criteria upon filing, citing erroneous
M-21 references that failed to reinforce why VA did not address the
dependency issue when adjudicating the veteran's claim. This is
preposterous and speaks to the larger training issue of VA staff.
We received a number of reports from our office in Boise where
veterans have had to endure multiple examinations for the same
disability over and over. All seemingly attempting to reach a
conclusion that was desired by VA. In another example, a supplemental
claim was submitted electronically to VA for a specific veteran. The
claimants direct deposit information was already of record and,
therefore, not included on the application as he was already being
paid. Upon receipt of this new application, VA deleted his current
banking data and set him up to receive a physical check exposing him to
potential fraud, benefit and identity theft. On the same day, VA was
notified by our office that another of our claimants needed to adjust
his income and net worth for pension purposes. This veteran also
received a letter from VA telling him that his direct deposit
information had been updated and he would now receive a hard copy check
to his home address.
Intent to File
From the inception of the policy change in 2015 until the end of
fiscal year 2017, it was discovered that 17 percent, or nearly 23,000
ITFs received by VA were improperly processed. This resulted in more
than $72 million in underpayments to deserving veterans. A senior VA
manager reported that this program was deployed within 6 months from
inception and development, which affected VBAs business model, and
those six months were not enough to produce sound guidance. VA's own
Office of Inspector General OIG) reported that mandatory intent to file
(ITF) training, which was not made available to VA staff until January
2017, was deficient. Despite VA knowing that it had hastily and
indiscriminately fielded a flawed product, it took more than two years
to update their Veterans Benefits Management System (VBMS) to assist
rating personnel when assigning effective dates based on ITFs.
The under secretary for benefits acknowledged that there were
errors involving proper processing of ITFs, and agreed to implement
recommendations made by the VAOIG. This notwithstanding, the under
secretary did not agree that most errors occurred because standard
operating procedures had been published. The VFW does not concur;
neither does the OIG. Regardless of rules having been published in the
M21-1, VBMS User Guide and Delta Training, the under secretary held
that ``standard operating procedures were unnecessary for this critical
new approach to claims processing.'' The OIG found that to be
perplexing, as do we.
Military Sexual Trauma
On August 24, 2018, the VFW released a statement critical of the
handling of nearly 18,000 improperly decided claims related to military
sexual trauma (MST) that VA had received over the previous 36 months.
VA leaders assured us that a review would be conducted to determine
what course of action VA would take to make these dually victimized
claimants whole. While the headlines were alarming and reprehensible,
the VFW was not surprised by any of the OIG's findings. In our reading
of the report, we determined that, like most claims that are improperly
adjudicated, these claims seemed more the result of careless
development rather than a deeper systemic problem or bias against
victims of MST. In fact, VA's own figures on MST claims processing show
the year covered by the OIG investigation was actually more successful
in adjudicating MST claim grants than prior years.
The VFW finds it inexcusable that claimants who have experienced
this type of trauma and whom may have explained their circumstances
several times could be forced to relive the experience due to untrained
adjudicators; adjudicators who must adhere to unrealistic timelines; or
adjudicators who are beholden to a flawed work credit system. The VAOIG
concurs with our position that inaccurate claims decisions related to
MST may lead to additional psychological harm to MST victims.
In all of these scenarios, the VFW maintains that proper,
consistent, and pointed training will result in better outcomes for VA
and its customers. Benefits Assistance Service (BAS) has testified
before this very committee, as recently as two weeks ago, that it
delivers training in a number of ways and on a number of topics to
better serve veterans. If in fact the training were effective and
overseen, we probably would not be in the current situation. VA needs
to get it right the first time, every time. The welfare of our veterans
requires it. Thousands of man hours and millions of dollars have been
spent on modernization, yet despite VA's best efforts, it continues to
find ways to put corners on a circle. If quality training is not
developed and implemented, and so-called efficiencies overseen,
veterans and their families pay the price. As said in our opening
statement, the VFW has been embedded in the claims process for longer
than VA has existed. We have always been able to provide local
mediation to assist VA in getting it right, only to be told in the name
of efficiency that we can no longer do that.
In closing, the VFW does believe that VBA is headed in the right
direction philosophically in establishing a fully electronic and easily
accessible claims process. However, VA still has significant problems
in the system that need to be addressed, starting with the unrealized
efficiencies of NWQ and the seeming lack of authority for VAROs to
resolve claims issues at the lowest possible level.
With the inconsistencies the VFW has seen over the past couple of
years, it becomes clear that the efficiencies and innovations that VA
seems extraordinarily proud of do not exist in the eyes of veterans and
the family members who continue to suffer delays and denials due to
incorrect rating decisions. We hope this subcommittee takes a hard look
at these issues and works to resolve them in a way that truly benefits
veterans.
Mr. Chairman, this concludes my testimony. Again, the VFW thanks
you and Ranking Member Esty for the opportunity to testify on these
important issues before this subcommittee. I am prepared to take any
questions you or the subcommittee members may have.
Prepared Statement of Shane L. Liermann
Chairman Bost, Ranking Member Esty, and Members of the
Subcommittee:
Thank you for inviting DAV (Disabled American Veterans) to testify
regarding the Department of Veterans Affairs (VA) development and
implementation of policy initiatives and the reasons for the challenges
identified in three recent VA Office of Inspector General (OIG)
Reports.
Mr. Chairman, as you may know, DAV is a congressionally chartered
national veterans' service organization of more than one million
wartime veterans, all of whom were injured or made ill while serving on
behalf of this nation. To fulfill our service mission to America's
injured and ill veterans and the families who care for them, DAV
directly employs a corps of more than 260 National Service Officers
(NSOs), all of whom are themselves wartime service-connected disabled
veterans, at every VA regional office (VARO) as well as other VA
facilities throughout the nation. Together with our chapter,
department, transition and county veteran service officers, DAV has
over 4,000 accredited representatives on the front lines providing free
claims and appeals services to our nation's veterans, their families
and survivors.
We represent over one million veterans and survivors, making DAV
the largest veterans service organization (VSO) providing claims
assistance. This testimony reflects the collective experience and
expertise of our thousands of dedicated and highly trained service
officers.
DAV is deeply concerned over the findings of significant
deficiencies in three VA OIG reports from July and August of this year.
As revealed by these reports, the reasons for these substantial errors
can be broken down into three main categories: training; IT systems
development and resources; and quality review. As we will conclude,
these deficiencies could be mitigated with the adoption of a VBA-wide
strategic formula for application prior to implementation of any new
changes, processes, benefits or IT systems.
``UNWARRANTED MEDICAL REEXAMINATIONS FOR DISABILITY BENEFITS''
On July 18, 2018, VA OIG published its findings on ``Unwarranted
Medical Reexaminations for Disability Benefits''. The OIG team reviewed
a statistical sample of 300 cases with reexaminations from March
through August 2017 and found that employees requested unwarranted
medical reexaminations in 111 cases. Veterans Benefits Administration
(VBA) employees requested reexaminations for veterans whose cases
qualified for exclusion from reexamination for one or more of the
following reasons:
Over 55 years old at the time of the examination, and not
otherwise warranted by unusual circumstances or regulation;
Permanent disability and not likely to improve;
Disability without substantial improvement over five
years;
Claims folders contained updated medical evidence
sufficient to continue the current disability evaluation without
additional examination;
Overall combined evaluation of multiple disabilities
would not change irrespective of the outcome of reexamining the
condition;
Disability evaluation of 10 percent or less;
Disability evaluation at the minimum level for the
condition.
The three main reasons for the requested unwarranted examinations
were lack of pre-examination reviews, lack of system automation and
inadequate quality assurance reviews.
Lack of Pre-Examination Reviews
VBA policy requires a pre-exam review of the veteran's claims
folder prior to requesting that a veteran appear for a medical
reexamination to determine whether the reexamination is needed. It was
estimated that 15,500 of 19,800 unwarranted reexaminations (78 percent)
lacked a pre-exam review. Determining the necessity of a reexamination
was a Ratings Veterans Representative Specialist (RVSR) responsibility,
however, in 2017, this task was removed from RVSR performance standards
as they do not receive work credit for this function. It has been
assigned to Veterans Representative Specialists (VSRs). Bypassing the
pre-exam review caused unwarranted reexaminations because VSRs lacked
the training and experience needed to determine whether a reexamination
is warranted. Similarly, 14 of the 24 VSRs interviewed told the review
team that they were unfamiliar with the criteria for determining
whether a reexamination was necessary. In addition, managers with
Compensation Service's Quality Assurance Program indicated there would
be fewer unwarranted reexaminations if RVSRs reviewed cases before VSRs
request reexaminations.
Lack of System Automation
VBA did not invest in developing alternative internal controls to
make up for the lack of a pre-exam review, such as information system
automation. Veterans Benefits Management System (VBMS) automation to
address pre-examination review, is scheduled for FY 2019 or later.
However, VBA did not maximize any of their electronic automation
systems to help prevent employees from requesting unnecessary
reexaminations.
Inadequate Quality Assurance Reviews
VBA's quality assurance program measures claims processing accuracy
for each VARO and for individual employees and provides feedback and
training. The program consists of the Systematic Technical Accuracy
Review (STAR) office and the Quality Review Teams (QRT). Neither the
STAR office nor the QRT measured whether VBA employees requested
reexaminations only when necessary or whether they conducted pre-exam
reviews. The Deputy Under Secretary for Field Operations and the
Director of Compensation Service both agreed with the need for
modifying VBA's quality review processes to include a review of
reexaminations, and with conducting a special focused quality
improvement review in this area.
Impact of Unwarranted Medical Reexaminations for Disability Benefits
The review team estimated that during the six-month review period,
VBA spent $10.1 million on unwarranted reexaminations. It also
estimated that VBA would waste $100.6 million on unwarranted
reexaminations over the next five years unless it ensures employees
only request reexaminations when necessary. The review team estimated
that VBA required 19,800 veterans to report for unwarranted medical
reexaminations during the review period. Approximately 14,200 veterans
experienced no change to their disability evaluations. The
reexaminations resulted in proposed benefit reductions for about 3,700
veterans.
Veterans and their families depend on their VA benefit payments to
provide a better quality of life. VA has threatened that quality of
life by creating unwarranted examinations that possibly led to
thousands of veterans having their compensation benefits significantly
reduced.
``PROCESSING INACCURACIES INVOLVING VETERANS' INTENT TO FILE
SUBMISSIONS FOR BENEFITS''
On August 21, 2018, VA OIG published its findings on ``Processing
Inaccuracies Involving Veterans' Intent to File Submissions for
Benefits''. The OIG review team found that VBA staff did not always
assign correct effective dates for compensation benefits with Intent to
File (ITF) submissions. VA OIG estimated that 22,600 of 137,000 cases
(17 percent) completed from March 24, 2015, through September 30, 2017,
had incorrect effective dates assigned for compensation benefits
whenever a veteran submitted an ITF.
The OIG review team selected a sample of 300 cases completed from
March 24, 2015, through September 30, 2017, to determine the accuracy
of effective dates assigned. Most of the errors occurred from March 24,
2015, through July 21, 2016, during the initial ITF implementation
period. The OIG estimated that in 15,200 of 35,400 cases (43 percent)
completed during that period, rating personnel assigned incorrect
effective dates. Most of the errors occurred with electronic ITF
submissions.
VBA modified its ITF procedures on July 22, 2016, to include
guidance and specific details on how to identify ITFs received
electronically or by mail. The OIG review team estimated that in 6,000
of 66,400 cases (9 percent), rating personnel assigned incorrect
effective dates. The number of errors decreased significantly during
the post-procedure update period ranging from July 22, 2016, through
June 12, 2017. Significant improvement was shown following the initial
ITF implementation period, with the improper processing of effective
dates decreasing from a 43 percent error rate to 4 percent.
The reasons for the ITF processing inaccuracies were summed up as
absence of standard operating procedures, inadequate procedural
guidance on electronic ITF submissions, deficient and delayed ITF
training, quality assurance and VBMS lacked functionality.
Absence of Standard Operating Procedures
When VBA initially implemented the ITF policy, its procedures
mainly focused on what to do with an incomplete ITF and how to enter
ITF data into VBMS. However, the guidance did not give rating personnel
instructions on how to identify the electronic submission of an ITF.
The Compensation Service's office of Procedures' lack of standard
operating procedures when implementing ITF guidance contributed to a
high error rate.
Inadequate Procedural Guidance on Electronic ITF Submissions
VBA's Compensation Service Acting Assistant Director and program
analysts for Procedures provided inadequate procedural guidance
associated with ITF submissions. The manual procedures in use from
March 24, 2015, through July 21, 2016, lacked details on the
identification of electronic ITF submissions for rating personnel to
correctly assign effective dates, despite numerous updates.
The Acting Assistant Director for Policy stated that the ITF
process was not part of the original proposed rule but resulted from
negative feedback received from Veterans Service Organizations about
the elimination of the informal claim process. Consequently, VBA had to
restructure policies, procedures, and claims processing systems within
a short time frame.
Deficient and Delayed ITF Training
The OIG reviewed all completed mandatory ITF-related training from
March 2015 through March 2017 and determined that the training
completed before March 2017 was deficient; because it lacked specific
information related to identifying an electronically submitted ITF.
Compensation Service provided the OIG with an instructional video
dated March 2015. Although the video provided instructions on how to
record the receipt of an ITF in VBMS, it did not show how rating
personnel would locate an electronically submitted ITF. Furthermore, a
program analyst for Procedures indicated the video was later removed
because it was not compliant with accessibility standards. The OIG was
unable to substantiate whether any staff were able to view this video
because it was no longer available.
Quality Assurance
In March 2016, Quality Assurance conducted a national quality call
to inform VBA staff of an error trend with effective dates and ITF.
Based on the error trend, Quality Assurance provided explicit
instructions on how to identify the presence of an electronic ITF
filing in VBMS. It took until July 22, 2016, approximately four months
from identification of the error trend, to provide these instructions.
The VBA official reported that the development of mandatory
training should ideally occur within a three-month time frame following
identification of an error trend, depending on other competing
priorities. Mandatory training was created and made available to rating
personnel in January 2017. The same official required VARO staff to
complete the training by March 31, 2017, a delay of approximately one
year following the discovery of the error trend.
Impact of ITF Processing Inaccuracies
Compensation Service's absence of standard operating procedures,
inadequate procedural guidance for electronic ITF submissions,
deficient and delayed mandatory training, and lack of VBMS
functionality resulted in improper payments made to veterans from March
24, 2015, through September 30, 2017.
Of the 22,600 cases with errors, 21,900 (97 percent) resulted in
underpayments and represent money that should have been paid to
veterans between the correct effective date and the one assigned. On a
national level, this resulted in the OIG's findings of an estimated
monetary impact of $72.5 million in under payments to veterans and
their families.
In many cases, earned benefits from the VA, prevent veterans and
their families from being homeless or at-risk of homelessness.
Therefore, it is unconceivable that VA would act so slowly to correct
their severe under payments. To correct also possible deficiencies and
to afford justice to all veterans affected, we recommend that VA review
all ITF submissions from March 24, 2015 to the present and correct all
under payments.
``DENIED POST-TRAUMATIC STRESS DISORDER CLAIMS RELATED TO MILITARY
SEXUAL TRAUMA''
On August 21, 2018, VA OIG published its findings on ``Denied Post-
traumatic Stress Disorder Claims Related to Military Sexual Trauma''.
The OIG report team stated that VBA staff did not always follow VBA's
policy and procedures, which may have led to the denial of veterans'
military sexual trauma (MST)-related claims.
In reviewing the MST-related claims denied by VBA, the review team
found that staff did not follow the required claims processing
procedures. The most commonly encountered errors in processing were:
Evidence was enough to request a medical examination and
opinion, but staff did not request one;
Evidence-gathering issues existed, such as VSRs not
requesting veterans' private treatment records;
MST Coordinators did not make the required telephone call
to the veteran, or VSRs did not use required language in the letter
sent to the veteran to determine whether the veteran reported the
claimed traumatic event in service and to obtain a copy of the report;
and
RVSRs decided veterans' claims based on contradictory or
otherwise insufficient medical opinions.
The reasons the MST-related claims were incorrectly processed were
lack of previous specialization, lack of additional level of review,
discontinued special focused reviews and inadequate training.
Need for Specialization
VBA previously implemented the Segmented Lanes model. It had
required VSRs and RVSRs on Special Operations teams to process all
claims VBA deemed highly complex, as well as sensitive issues such as
MST-related claims. The OIG review team concluded that staff on the
Special Operations teams developed subject matter expertise on these
highly sensitive claims due to focused training and repetition. Under
the National Work Queue (NWQ), VBA no longer utilized the Special
Operations teams. Under this new model, the NWQ distributed claims
daily to each VARO and the VARO determined the distribution of MST-
related claims.
As a result, MST-related claims could potentially be processed by
any VSR or RVSR, regardless of their experience and expertise. The OIG
review team determined VSRs and RVSRs at offices that did not
specialize, lacked familiarity and became less proficient at processing
MST-related claims.
VARO staff suggested VBA reestablish specialized processing,
allowing employees to develop the necessary expertise to ensure
consistency and accuracy in processing these sensitive claims. The
Deputy Under Secretary for Field Operations agreed that dedicated staff
working MST-related claims would help improve the quality of claims
processing.
Lack of Additional Level of Review
VBA currently requires an additional level of review for some types
of complex claims, such as traumatic brain injury cases, but does not
require this additional level of review for MST-related claims. RVSRs,
quality review personnel, and supervisors interviewed at the four VAROs
visited generally thought an additional level of review would be
helpful and could improve accuracy. An additional level of review
serves as an internal control and quality check to help ensure:
Claims processors followed all applicable statutes,
regulations, and procedures;
Evidence of record properly supports the decision; and
RVSR adequately explained the decision.
The Deputy Under Secretary for Field Operations and Compensation
Service Quality Assurance personnel agreed that an additional level of
review would help improve the accuracy of processing MST-related
claims.
Discontinued Special Focused Reviews
The national Systematic Technical Accuracy Review (STAR) team for
Compensation Service and the Quality Review Teams (QRT) at each VARO
execute VBA's quality assurance programs. MST-related claims are
included in the STAR and QRT claim reviews. However, MST-related claims
are only a small percentage of the overall claim volume and are less
likely than other claim types to be randomly selected for STAR and QRT
reviews. Therefore, STAR and QRT staff did not frequently review them.
STAR staff completed special focused quality improvement reviews of
MST-related claims beginning in 2011, based on the deficiencies
identified in a 2010 OIG report related to combat stress in women
veterans. These reviews continued based on a 2014 Government
Accountability Office (GAO) report on MST-related claims that found the
problems persisted. Staff performed the reviews twice a year and
identified errors like those this OIG review team found, such as missed
evidence or markers and failure to request necessary medical
examinations.
The STAR office stopped completing special focused quality
improvement reviews of MST-related claims in December 2015. VBA's
Quality Assurance Officer indicated the STAR office stopped performing
special focused quality improvement reviews because it had met the GAO
requirement. The Assistant Director of Quality Assurance for
Compensation Service also stated that they reallocated resources
towards other areas because the error rate declined for MST-related
claims from 2011 to 2015.
Given the high error rate identified during its review, the OIG
review team determined the STAR office should reinstate special focused
quality improvement reviews of MST-related claims.
Inadequate Training
Compensation Service delivered MST training through four modules
using VBA's online training management system. The OIG reviewed the
four training modules and identified the following issues:
Consistently referred to a development checklist that was
outdated and inaccurate;
Included erroneous development procedures, such as
instructing claims processors to use incorrect medical opinion
language;
Misstated the MST Coordinator's role and
responsibilities;
Did not address how to rate claims where a diagnosis
other than PTSD was provided; and
Included incomplete information regarding what
constitutes an insufficient or inadequate examination.
The MST-related claims training was one-time only and there was no
requirement for annual refresher training. The Compensation Service
Quality Assurance Officer stated that VSRs and RVSRs needed refresher
training, and staff at the four VAROs visited, generally agreed it was
not adequate. The Director of Compensation Service and Assistant
Director of Compensation Service Training agreed that the training
needed improvement and indicated that VBA was in the process of
creating a new training program. The Deputy Under Secretary for Field
Operations stated that training for MST-related claims should be an
annual requirement.
Impact of Improperly Adjudicated MST-Related Claims
The review team found that VBA staff did not properly process
veterans' denied MST-related claims in 82 of 169 cases. As a result,
the OIG estimated that VBA staff incorrectly processed approximately
1,300 or 49 percent of the 2,700 MST-related claims denied during that
time. Due to the severity and volume of these errors, VA OIG
recommended that VBA review all denied MST-related claims since the
beginning of FY 2017 and reopen the cases with errors to ensure
veterans receive accurate claims decisions as well as better customer
service.
Those who experience sexual military trauma often suffer in
silence. However, nearly 50 percent of those claiming MST-related PTSD
have been denied due to VA's own failures. How long will these veterans
continue to suffer without justice?
PATTERN OF SYSTEMIC FAILURES
The VA's requesting unwarranted examinations was estimated to
require 19,800 veterans to report for unwarranted medical
reexaminations during the review period at a cost of over $10 million.
The report specifically noted that these were caused by lack of
training, lack of automated systems, and no quality review.
VBA's absence of standard operating procedures, inadequate
procedural guidance for electronic ITF submissions, deficient and
delayed mandatory training, and lack of VBMS functionality resulted in
improper payments made to veterans.
49 percent of denied MST-related claims were processed incorrectly
and were not processed within VBA's own guidelines and policies. The
reasons the MST-related claims were incorrectly processed were lack of
previous specialization, lack of additional level of review,
discontinued special focused reviews and inadequate training.
The new VA OIG report ``Accuracy of Claims Involving Service-
Connected Amyotrophic Lateral Sclerosis'' released on November 20,
2018, continues to show these same patterns. The report projected that
430 of the 960 total ALS veterans' cases (45 percent) completed during
the six-month review period had erroneous decisions. It was recommended
that VBA provide additional training, better quality review and add
functionality to VBMS.
RECOMMENDATIONS
As demonstrated, VBA's erratic training, lack of planning for IT
systems development and uneven quality review has wasted millions of
taxpayers' dollars, as well as underpaid, denied and reduced thousands
of veterans. While VA is implementing the recommendations from the VA
Office of Inspector General, we believe VA needs to develop proactive
measures to lessen these preventable errors in the future.
VA has used production goals and other metrics to drive down the
backlogs of claims and appeals and provide timely decisions. However,
as noted by the OIG reports, VA is not placing enough emphasis on
comprehensive training and quality review. As evidenced, lack of
training and improper quality review of claims decisions led to
multiple denied claims, reduced benefits, unnecessary examinations
conducted, and inaccurate effective dates for claimants.
Training and feedback are instrumental in shifting VA's culture to
one primarily driven to achieve quality, rather than merely
productivity. After all, proper quality review, training, and feedback
will lead to more claims decisions being made right the first time, and
thereby lead to a reduction of appeals.
Updated and modern IT is critical to the ultimate success of VBA.
Despite past failed attempts to modernize its claims processing systems
over the past two decades, VBA made a critical decision to transform
its paper-based systems and replace them with streamlined business
processes supported by modern IT systems. However, unless VBA is
provided sufficient resources to fully implement and program new IT
systems at the front end, both productivity and quality will continue
to suffer, resulting in more errors and veterans waiting longer to
receive their earned benefits.
Over the past several years, VBA has developed and implemented new
IT systems to support the transformations, including VBMS, the NWQ, and
e-Benefits. Unfortunately, VBA must compete with other offices and
agencies within VA for the limited IT funding available each year,
delaying development and deployment of critical IT systems and
programming. As a result, critical IT systems are rarely fully
developed before business process changes are implemented; instead they
are phased in over several years, forcing VBA to rely on an
inconsistent mix of old and new IT systems, as well as an endless
stream of suboptimal ``work around'' solutions.
While it may be understandable from a purely budgetary view to
stretch out development and deployment of new IT systems, it is a
failure from a functional perspective. Providing only partial IT
solutions inevitably results in a loss of productivity, and often leads
to lower quality and less accurate decisions on claims and appeals by
veterans. Similar problems caused by inadequately developed technology
can be seen in the Vocational Rehabilitation and Employment's (VR&E)
$12 million IT debacle and the Education Service's continuing problems
in making accurate payments under the new GI Bill program.
As VA is correcting the deficiencies outlined in the OIG reports,
we believe that if VA shifts from a reactive position to a preemptive
and aggressive approach to future changes and new policies, they can
lessen the types of errors noted. VA needs to devote their attention to
developing a process to address future changes and potential new
policies in advance of the actual changes.
We recommend VBA to create a systematic strategic review process
for new policies and initiatives. This could encompass each appropriate
VA office potentially impacted by the changes, such as VA Office of
Training, VA Quality Assurance and Review, VA IT services including
VBMS and NWQ. However to be truly effective, it requires VSOs and other
stakeholders, as well as VA's front line subject matter experts
including RVSRs and VSRs.
This systematic strategic review process should be focused on
vetting new policy initiatives to prevent unintended consequences that
can negatively impact veterans and their families. It would be better
for VA to invest time and resources preventing these problems from
occurring rather than developing ``work arounds'' and patches after the
veterans have already been harmed.
A good example is how VBA, VA Agencies, GAO, VSOs, and stakeholders
were all engaged from the beginning in the development of the Appeals
Modernization Act (AMA). Before the implementation of the AMA, VBA and
BVA have collaborated to develop IT infrastructure, training programs,
and quality review. This type of systematic strategic review process
will lessen the preventable errors noted by the VA OIG reports.
Mr. Chairmen, this concludes my testimony on behalf of DAV. I would
be happy to answer any questions you or other members of the
Subcommittees may have.
Prepared Statement of Greg Nembhard
Chairman Bost, Ranking Member Esty and distinguished members of the
Subcommittee on Disability Assistance and Memorial Affairs, on behalf
of National Commander Brett P. Reistad and the nearly two million
members of The American Legion, we thank you for the opportunity to
testify on the Deartment of Veterans Affairs' (VA) development and
implementation of policy initiatives. As the largest patriotic service
organization in the United States, with a myriad of programs supporting
veterans, The American Legion appreciates the committee focusing on
these critical issues that will affect veterans and their families.
Background
The Department of Veterans Affairs Office of Inspector General
(VAOIG) published three reports about unwarranted medical reexamination
for disability benefits, processing inaccuracies involving veterans'
intent to file submissions for benefits and denied Post-Traumatic
Stress Disorder (PTSD) claims related to Military Sexual Trauma (MST),
in July and August 2018.
Congress approved the use of contract examiners within the Veterans
Benefits Administration (VBA) in 1996 to expedite the scheduling of
disability exams, so the Veterans Health Administration (VHA) can focus
resources on treating patients. VA dramatically expanded the size and
cost of the program since its inception. On November 15, 2018, the
United States House of Representatives Committee on Veterans Affairs
Disability Assistance and Memorial Affairs (DAMA) Subcommittee held a
hearing regarding VA oversight of contract disability examinations and
the use of contractors to provide disability examinations. The
Government Accountability Office's (GAO) testimony before the
Subcommittee illuminated how VBA has limited information regarding
whether contractors who conduct disability compensation medical exams
are meeting the VA's quality and timeliness targets. \1\ Contracted
providers perform approximately half of VA's disability examinations,
and their national accuracy rate does not achieve VA's prescribed 92
percent accuracy goal. \2\ These findings raise The American Legion's
concerns about numerous factors. Specifically, the accuracy of claims
decisions, the adequacy of training for contractors, VA's inability to
comply with timeliness goals, and whether or not the cost of
contracting these services would be considered exorbitant if program
oversight and management were factored in, bringing services up to par
with VA standards.
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\1\ VA DISABILITY EXAMS Improved Oversight of Contracted Examiners
Needed, GAO Testimony, November 2017
\2\ U.S. Department of Veterans Affairs Annual Performance Plan and
Report, Accuracy Goals Table
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The American Legion believes that our nation's heroes should not
suffer at the hands of institutions whose existence and mission is to
care for them. We believe in quality of care at VA facilities, remain
committed to a strong VA, and that VA is a ``system worth saving.''
System Worth Saving
The System Worth Saving program, created in 2003, by then-American
Legion National Commander Ron Conley, focuses on what works best at VA
Medical Centers (VAMC), identifies any challenges, and makes
recommendations that help veterans. The mission of the System Worth
Saving program is to assess the quality and timeliness of veterans'
health care, the claims process at VA Regional Offices (VARO), and
provide feedback from veterans about the care and services offered. We
conduct site visits at VAMCs and Regional Offices nationwide. The
American Legion compiles the reports from our visits into a publication
for distribution to the President of the United States, Congress, VA
officials, and members of The American Legion. A copy of which can be
found at: https://www.legion.org/systemworthsaving. The compressive
report provides an understanding of VA challenges, best practices, and
offers recommendations based on our observations through our nearly 100
years of experience.
Unwarranted Medical Reexaminations for Disability Benefits
The VAOIG conducted a review to determine whether VBA employees
required disabled veterans to report for unwarranted medical
reexaminations. \3\ VBA employees have authority to request
reexaminations for veterans ``whenever VA determines there is a need to
verify either the continued existence or the current severity of a
disability,'' and when there is no exclusion from reexamination. \4\
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\3\ VBA also refers to medical reexaminations as routine future
examinations.
\4\ 38 CFR Sec. 3.327, Reexaminations
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The VAOIG found that VBA did not consistently follow policy
regarding reexamination requests. The Inspector General's office found
that VBA required unwarranted medical examinations in 19,800 of the
53,500 cases in the review period (37 percent). \5\ The OIG review team
estimated that during the six-month period, VBA spent $10.1 million on
unwarranted reexaminations - $5.3 million involving VHA clinicians, and
$4.8 million involving VBA contractors.
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\5\ VA OIG 17-04966-201, Page i, July 17, 2018
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Intent to File (ITF)
The VAOIG sought to determine whether VBA assigned correct
effective dates on claims for compensation benefits with an intent to
file (ITF). VA issued guidance to require claims for benefits be filed
on standard forms to improve the quality and timeliness of processing
veterans' claims in March 2015. VA acknowledged that some veterans
might need additional time to gather all of the information and
evidence necessary in support of their claims; therefore, VA allows
applicants to notify them of their intent to file a claim to establish
the earliest possible effective date for benefits, if determined
eligible.
The VA's Acting Assistant Director for Procedures stated that the
absence of granularity in the procedural guidance is a cause for the
processing inaccuracies. The Assistant Director also indicated that the
ITF process was an initiative with a six-month implementation and
delivery period. \6\ VA's effort affected VBA's policy and procedures
considerably. VBA asserted that six months was not enough time to
produce sound guidance, restructure policies, procedures, and claims
processing systems. The VA's Acting Assistant Director for Policy
stated that VBA produced a minimally viable product, as related to
system functionality because of time constraints. The VA published the
proposed rule to implement ITF on October 31, 2013, and finalized it on
September 25, 2014. VA bears responsibility for setting the time frame
of implementation. They led the initiative and set the deadlines before
publishing the proposed rule more than five years ago.
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\6\ VA OIG 17-04919-201, Page ii, August 21, 2018
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PTSD and MST
MST can lead to PTSD, but VA denies granting MST victims benefits
based on a claim of PTSD because they cannot produce the required
evidence to support the occurrence of the reported assault. Victims of
MST have difficulty providing the necessary evidence because reporting
the incident when it occurs is challenging. Victims of MST typically do
not report the incident due to concerns about negative implications for
performance reports, worries about punishment for collateral
misconduct, and the perception of an unresponsive military chain of
command. VBA issued guidance in 2011 to ensure consistency, fairness,
and a ``liberal approach'' regarding acceptable types of evidence to
support and identify stressors related to MST that can lead to PTSD.
\7\
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\7\ VBA Training Letter, Adjudicating PTSD Claims Based on MST.
(Historical)
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A review team assessed a sample of 169 MST-related claims denied
during the review period, according to the VAOIG report dated August
21, 2018. The review found that VBA did not correctly process veterans'
denied MST-related claims in 82 of 169 cases. VAOIG estimated that VBA
incorrectly processed approximately 1,300 of the 2,700 MST-related
claims denied during that time (49 percent) as a result. \8\ This is
unacceptable. Finding ways to ensure these veterans receive the
services they deserve is one of the highest priorities of The American
Legion.
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\8\ VA OIG 17-05248-241, Page ii, August 21, 2018
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What is The American Legion Doing
The American Legion continues to work directly with veterans to
help them overcome challenges associated with access to VA health care
and the claims process, and through our System Worth Saving program
provides first-hand observations and analyses to VA and members of
congress
Recent VAOIG reports cited inaccuracies, timeliness issues, lack of
specialization, inadequate training, and overall poor quality of VA
examinations completed by contracted medical examiners. The American
Legion seeks to protect veterans from these, and other inadequacies. A
variety of factors cause these shortfalls, including a lack of funding,
understaffed VA facilities, and unscrupulous contracting companies who
solely focus on their bottom line -at the veterans' expense. The
American Legion works closely with and urges the VA to take swift
corrective action.
Recommendations
VA's hiring and incentives process need greater emphasis. If VA
needs additional resources to secure fulfillment of critical positions
to complete tasks associated with exams, The American Legion calls on
VA to communicate that need to Congress and urge Congress to allocate
the necessary funding to make those critical hires. This will ensure
veterans receive the prompt care they need within the system that is
designed to treat the unique nature of their wounds.
The American Legion encourages Congress to conduct oversight to
ensure veterans receive adequate and comprehensive VA examinations. We
also urge the secretary of VA to establish appropriate requirements for
examiners and to enforce the use of those requirements. The American
Legion also urges the VA secretary, through resolution, \9\ to review
the effectiveness of the requirements for examiners, including
contracted disability compensation medical exams, and how that
effectiveness impacts the appropriate ratings for compensation claims.
The American Legion understands VA is working hard to eliminate
unnecessary reexaminations, but timeliness and functionality of
processing systems associated with ITF must be addressed to avoid
additional costs and inconvenience to veterans and their families.
---------------------------------------------------------------------------
\9\ The American Legion Resolution No. 87: Establishing and
Enforcing Requirements for Contract Examiners Conducting Medical
Examinations for VA Compensation Purposes
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The American Legion continues to advocate for the improved delivery
of timely and quality health care for women using VA, including
specific attention to MST-related claims. The proportion of female
servicemembers and veterans is at its highest point in history, with
projections for continued growth. \10\ The growing numbers of female
veterans mean that a system which primarily provided care to male
enrollees must now evolve, and adapt, to meet the needs of both male
and female veterans. Veterans, regardless of gender, must receive the
best possible care from VA, and the system needs to continue to adjust
to the changing demands of the population it serves. VA must develop a
comprehensive health care program for female veterans that extend
beyond reproductive issues.
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\10\ Department of Veterans Affairs Study of Barriers for Women
Veterans to VA Health Care, April 2015
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Conclusion
Chairman Bost, Ranking Member Esty, and distinguished members of
this veteran-centric committee, The American Legion thanks you for the
opportunity to illuminate the positions of the nearly two million
veteran members of this organization.
Ensuring those who have selflessly raised their right hand in
defense of this nation receive the benefits and care they deserve is a
priority of The American Legion, and by the action of this committee,
we can see that it is for you as well.
For additional information regarding this testimony, please contact
Ms. Lindsay Dearing, Legislative Associate in The American Legion's
Legislative Division at (202) 861-2700 or [email protected].
Statements For The Record
American Federation of Government Employees, AFL-CIO (AFGE)
December 12, 2018
Chairman Bost, Ranking Member Esty, and Members of the Committee:
On behalf of the American Federation of Government Employees, AFL-
CIO (AFGE), and its National VA Council, which represents more than
700,000 federal and D.C. Government Employees, including over 250,000
front line employees at the Department of Veterans Affairs (VA) who
provide vital care and services for our veterans, I write to you today
about the hearing held by the House Committee on Veterans' Affairs,
Subcommittee on Disability Assistance and Memorial Affairs (DAMA) on
November 29, 2018 titled ``VA's Development and Implementation of
Policy Initiatives.'' This includes serving as the representatives of
staff who work throughout the Veterans Benefits Administration (VBA)
and are on the front lines serving veterans every day. In turn, AFGE
has several comments on how proposed policy changes by VBA will impact
the VBA workforce and its mission to serve veterans.
The National Work Queue:
During the hearing, members of subcommittee addressed several
aspects of the National Work Queue (NWQ), and how in many ways it has
hurt veterans. First and foremost, AFGE agrees with the Inspector
General's (IG) conclusion that eliminating specialization has had a
detrimental impact on veterans with claims, particularly those that are
more complex and sensitive in nature. As the IG report explains, prior
to the implementation of the NWQ:
The Segmented Lanes model required VSRs and RVSRs on Special
Operations teams to process all claims VBA designated as requiring
special handling, which included [Military Sexual Trauma]-related
claims. By implementing the NWQ, VBA no longer required Special
Operations teams to review MST-related claims. Under the NWQ, VSRs and
RVSRs are responsible for processing a wide variety of claims,
including MST-related claims. However, many VSRs and RVSRs do not have
the experience or expertise to process MST-related claims. \1\
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\1\ VA OIG 17-05248-241 / Page iii / August 21, 2018
Because of the level of difficulty in processing these claims, AFGE
would support returning these and other former ``Special Operations''
cases including Traumatic Brain Injury back to a specialized lane or
lanes in Regional Offices. Much like a doctor choosing to become a
pediatrician and not being expected to be an expert in podiatry, not
all VSRs and RVSRs should be expected to process highly specialized
cases.
Furthermore, AFGE encourages the VA to modify the NWQ so that cases
remain within the same regional office while they are being processed,
and that VSRs and RVSRs are more clearly identified on each case file.
This will allow for better collaboration between VSRs and RVSRs (as was
done prior to the implementation of the NWQ) and allow the staff of
Veteran Service Organizations to better assist their members.
Information Technology:
AFGE also believes that the VBA can create a better environment to
allow VBA employees to succeed by fixing Information Technology (IT)
problems plaguing the agency. Highlighting the written testimony of
Shane L. Liermann, Assistant National Legislative Director of the
Disabled American Veterans (DAV), AFGE agrees with several of the
recommendations made by DAV, including the need for VA to invest in and
improve its IT infrastructure by fixing system automation with the
Veterans Benefits Management System (VBMS). To quote Mr. Liermann:
Updated and modern IT is critical to the ultimate success of VBA.
Despite past failed attempts to modernize its claims processing systems
over the past two decades, VBA made a critical decision to transform
its paper-based systems and replace them with streamlined business
processes supported by modern IT systems. However, unless VBA is
provided sufficient resources to fully implement and program new IT
systems at the front end, both productivity and quality will continue
to suffer, resulting in more errors and veterans waiting longer to
receive their earned benefits.
Furthermore:
Over the past several years, VBA has developed and implemented new
IT systems to support the transformations, including VBMS, the NWQ, and
e-Benefits. Unfortunately, VBA must compete with other offices and
agencies within VA for the limited IT funding available each year,
delaying development and deployment of critical IT systems and
programming. As a result, critical IT systems are rarely fully
developed before business process changes are implemented; instead they
are phased in over several years, forcing VBA to rely on an
inconsistent mix of old and new IT systems, as well as an endless
stream of suboptimal ``work around'' solutions.
AFGE would add that these delays and ```work around' solutions''
make it more difficult for VBA employees to complete their duties, and
that VBA employees suffer negative impacts on their production and
quality ratings because of malfunctioning and uncooperative technology.
Training and Collaboration:
AFGE would also like to reiterate the DAV's points on the need for
improved training. Whether it is related to the ``Intent to File''
process for claiming benefits or special procedures for highly complex
claims including Military Sexual Trauma, the additional training given
to VBA employees will help them to better serve veterans and help them
prevent facing unfair discipline for mistakes that they did not know
how to avoid. With the misuse of the Department of Veterans Affairs
Accountability and Whistleblower Protection Act of 2017 by VA
management to unnecessarily terminate employees, the more training
employees receive, the more likely they will be able to grow in their
positions instead of constantly fearing removal.
Lastly, as the subcommittee and the VA decide what polices to
implement in the future, as a stakeholder AFGE expects to be consulted.
As the front-line employees processing the claims and using the IT in
practice, and not just in planning, AFGE strongly encourages the VA to
consult with AFGE, the exclusive representative of employees who have
extensive experience and expertise and actually perform these duties.
Thank you, and I respectfully request that this letter be submitted
for the record.
Sincerely,
Thomas S. Kahn
Director, Legislative Affairs
American Federation of Government Employees, AFL-CIO
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