good evening ladies and gentlemen the veterans affairs disability assistance a memorial fair subcommittee hearing on addressing the backlog can be a manage one million claims will now come to order  would ask for everyone to rise to the pledge of allegiance pledge flags are located at both ends of the room i pledge allegiance to the united states of america and to the republic for which stands one nation under god floor tonight some members felt that we should vote three times on measures that were already passed including their own amendments  and revote and then reconsider the revote of those measures and for that reason that this hearing is starting now instead of at two o'clock having said that i would tell you that the members of this veterans applying for the very benefits that they have earned through sacrifice to our country languishing in a growing song of some of these veterans have been waiting months years and some mind boggling cases even decades is this how america fulfills its promise to our veterans when men men and women sign up to put on the uniform and defend our country a contract we need to make sure that america is living up to our part of the contract we must have as an advocate for veterans not an obstacle moves away not one that puts up roadblocks to add perspective before we begin i want to offer some facts to reflect upon as we take up this discussion there are approximately twenty three point five million veterans living in america every year the v a treats roughly five million of these brave men and women and yet as large as these numbers may seem every year five hundred thousand additional veterans file a claim with  so that they can begin receiving treatment tragically they're frequently delayed or even denied they're delayed because of a broken system denied because paperwork is lost because legal hurdles and requirements are place above veterans needs sometimes they are delayed so long they die or just give up fighting to bureaucracy before their claim is processed and now as we will explore today there are nearly one million veterans waiting in limbo as a result make no mistake this is not a new issue and other members of this committee have been focusing on this intensely because it's so vital to regain the trust of our veterans and to provide them the treatment and the disability benefits that they were promised during the one hundred tenth congress i can be in fourteen hearings on disability claims and appeals processing issues as a result we were able to successfully pass the veterans disability benefits claims modernization act last october now public law one ten three eighty nine this legislation essentially mandated to modernize this ability claims processing system this hearing will now mark the fourth time will be addressing this subject this year and while we they're waiting for a nation to show its gratitude these veterans do not deserve to have their requests for assistance languish in the in the v a bureaucracy there must be a way to stem this tide veterans cannot wait any longer a requires a cultural management change that can only manifest itself if it embraces the very reason it was an act in the first place which is to serve veterans as chairman of the subcommittee i believe we have given v a the tools and the authority it needs to take the their stories like so many others illustrate the need for change i certainly hope that we can learn from their experience i know that the american legion v f w have worked diligently along with other v s o to address the destroyed practices that exist within the v a that have led to the situation i'm eager to hear from the american federation of government employees the newly formed disability compensation advisory committee and i place a great deal of hope in your work and progress i also look forward to hearing from the v a i know that your claims processing has improved in some respects i also know that the one million figure reflects all of your inventory not just compensation and pension pension  a consensus exists that we also have already been set in motion is my hope that the v a will transform itself into a modern better and focused system that can process one million claims accurately and timely one where veterans and their claims processing system and its ongoing efforts to improve timeliness and accuracy the struggle to overcome the backlog of disability claims has weighed upon the department for several years now despite multiple hearings on this issue as well as significant increases in v a budget workforce and information technology resources signs of progress are subtle we've addressed the situation from multiple angles funding for v programs has increased since one thousand nine hundred five there's been a seventy five percent increase in the number of full time claims workers in the last five years we've made a strong push toward modernizing the system so that it is electronic rather than paper based as mentioned earlier also and we've emphasized in reemphasize the need for training and accountability seems to be overwhelmed and it is well past time for frank assessment of what is going  on to be very candid and forthcoming about what it sees as the problem otherwise we cannot help fix it i understand that along with the aforementioned increase in funding is receiving a record number of claims along with an increased number of expect if this is a misperception i must know why every one of these claims represents an american veteran their patients and mine is growing very thin on this issue if we do not fix the problem now and merely pass it on to a future generation we will all be very much i'm certain everyone here shares my frustration so let's put the cards on the table and figure out what we can do i want to thank the witnesses for their service to our country and for their testimony today and i look forward to our discussion mr chairman thank you congressman lamborn i would like to remind all of our panelists that your complete written records have already been made a part of our hearing record veteran from gladstone oregon mr robert jackson assistant director national legislative service for veterans of foreign wars mr kerry baker the assistant national legislative director park you are not recognized for five minutes mr chairman ranking member the committee i have the american legion i would like to thank you for providing us with the opportunity to offer testimony  regarding the looming backlog and what can be done to handle the volume as it stands as well as to reduce or to improve the situation for veterans it's often said and i think this may be particularly relevant today that the definition of insanity is to repeat the same action over and over again respect expecting a different result we're at a point in the claims process in the v a simply increasing the volume of effort with the wrong tools in the existing system can't be lucian that will improve the current state of affairs we need to look at the system with fresh eyes and determine how a new outlook and help with the daunting task of managing a backlog such as this is not say that addition of additional work force is not beneficial indeed they have increased the workforce and that is a potential benefit however merely having more people making the same mistakes over and over again does not eliminate the problem of  appeals in cases that continue to bounce back and forth and get lost in the system as we mentioned in the past the way v a currently counts their workload does not encourage accuracy it encourages volume if a job is worth doing it's worth doing right do the job right the first time can't work credit is the same whether it's performed properly or whether details are overlooked in courage is because when the pressure is on an employee in the past isn't proposes the account work credit when a claim reaches a final decision in a manner that the encouragement will be to perform every aspect of the claim correctly as appeals over missed technical details which make up a large percentage of the claims returned from both the court and the board of system are for simple errors of procedure oversight things that can be avoided with accountability and attention to detail lack of proper examination lack of film and of the duty to assist veterans even simple errors and letters sent to veterans all can be corrected if the credit were counted for doing the job right not simply for shuffling the paper on to the next day all too often the claims on appeal are further delayed by multiple bounces back and forth between the board of veterans appeals and the appeals management center because the terms of the remand are not followed simply doing it right the first time and alleviate this and get the claims completed and out of the system the development of claims presents another opportunity for improvement many claims are over developed when the simple facts to grant service connection are already present needless exam searches for records continue to drag out the process furthermore regarding development the amendment of the understanding of section eleven fifty four which has been discussed in other legislation streamline and reduce a great deal of the burden of additional development on to hasten the process of decision the claims of veterans who are climbing incidents in combat  these are not unique to the current situation diabetes claims due to exposure to agent orange are often needlessly developed when the presumptions of exposure and connection have already been established in the veterans of already submitted private medical records indicating the severity of their conditions their claim their sent for redundant be exams rather than closing out a claim early when they have already been given all the tools they need to grant the claim one further area that's received attention of late and has been a sign of improvement of late but we must continue to push for improvement as the ability to accurately and rapidly obtain the requisite records needed to adjudicate a claim confusion over locations of veterans military records a lack of ability to communicate between different agencies and provide rapid access to the necessary information is something that is improving and can continue to be improved and must be a focus of attempting to overhaul the  system also presenting today as a veteran who can speak to this very problem in the course of compiling a three part story for the american legion magazine were made aware of mr dave who is seated next to me a veteran of the first gulf war firsthand experience of just prohack you are not recognized for five minutes mr chairman members of the committee thank you for their up today on behalf of american veterans including the veterans of the first gulf war with whom may have thank you mr go ahead and thank you for your service to this country mr jackson you're not recognized for five minutes mr chairman ranking member lamb born members of the subcommittee thank you for the opportunity to provide testimony before the subcommittee on the v a claims processing system one point six million men and women the veterans of foreign war appreciate the voice you give them at these important hearings within two years of the conclusion of world war two more than sixteen million service men and women were released from active duty millions filed claims with the v a for compensation why wasn't the v a overwhelmed perhaps it's time to recognize that better production and timeliness levels by the v a in the fifty's and sixty's may very well of been accomplished because there was less attention paid to procedural rights and that the v a may have exhibited a rather cavalier attitude when it came to interpreting the law and its own regulations whether you agree with the other view of history it's clear the v a was able to make claim decisions quickly reexamination were frequent and allowed to increase or reduce evaluations of disability worsened or improve today claims development takes longer quite simply congress recognized that past procedures and practices by the v a were not always veteran friendly did not adequately tell veterans what was needed and often lead to decisions based on less than all of the available evidence decisions are longer because congress decided that veterans should be told what evidence was considered and why benefits were denied or granted appeals take longer to resolve because of increased evidentiary unnoticed requirements direction of additional review level and decision review officers in the need to satisfy all judicial mandates the fact is there's nothing inherently wrong with any of these changes those decisions were all needed to fix recognised problems and abuses having said that how do you devise a system that allows the a to make decisions rapidly without increasing mistakes is not costly either to the veterans or the american people and continues to provide veterans with the protections that have been built into the law over the past sixty years jerry maguire who is the v f w deputy director of national veterans service with assistance from the staff alumni has developed a process that incorporates the best practices of a post world war two claim system to make expedited provisional decisions based on existing records this proposal which calls for the creation of a program entitled the provisional claims processing program would grant benefits on limited information quickly but with quality limited service members leaving the armed forces or recently discharged veterans of valuations would be based on existing evidence understanding that benefits for some conditions may be denied when further development would enable the v a to grant service connection under existing law inversely it is also understood that benefits based on existing evidence may not be service connected when all evidence eventually developed and considered consequently a grant of benefits for any disability is not a grant of service connection entitling the veteran to protections afforded by existing one regulation under this program for development of zammit in a new decision would be required four years after initial provisional rating provisional decisions made under this program would have no precedent value and service connection for all disabilities including any new condition the veteran chooses to place into contention would be made during the review at the for your point this program would restore the rapid delivery of benefits based on current rating standards while still maintaining veterans rights under a emma protections carefully crafted by congress over the past sixty years to dramatically increase decisions on original claims while allowing the bulk of staff to concentrate on resolving the existing backlog more importantly this program would provide a win for veterans in exchange for agreeing to wait for a final decision they would receive a provisional decision in benefits a matter of weeks instead of more than six months properly structured to fail the promise it made with the program that a decision could be made prior to further veterans would have the right choose which program they participate in after they know what the provisional decision awards if they disagree with the provisional decision they did not accept and since they know that the current program may take six months or more to produce a decision the conscious choice to accept the way should reduce the number of complaints and consequent pressure on congress mr chairman i'll be more than happy to provide you and members of the committee with this updated copy of the proposal this concludes my statement i would be happy to respond any questions know the claims process is extremely complex and lengthy with side over nine hundred forty thousand claims in two thousand and nine i suspect that number will be closer to one million this is encouraging since it's close to two side this year which is also close to two hundred thousand more than just a couple of years ago short of growing the workforce and there are no simple solutions to this problem the d e v on the left believes it has some solutions to support that believe we presented this committee with d e v s twenty first century claims process proposal which is intended to simplify the process while preserving resources and reducing expenditures our proposal begins with the initial stages of the claims process and continues through the entire appellate process our recommendations are aimed at making it in a fit efficient rather inefficient process without sacrificing a single benefit they include one however the veterans who are serving now in the present conflict are entitled to five years of health care after they demobilize after they are discharged from the military and it will run out after that point and will they will not be able to get health care for the conditions that are not service connected with regards to mental health care and many of the outreach clinics they are not in a position to be turning people away from trying to get the care they need but it's not always capable of getting the full level of care that particularly severe cases of mental disorders which can iraq it is possible to get some degree of health care within certain circumstances when you fall into certain categories as a veteran but in terms of an all inclusive group of veterans being able to receive health care if they're not service connected for a condition then that is not i would ask him or one more question if i may which is that some of the solutions highlighted in your testimony were already considered an act of congress and one turned three eighty nine do you think these provisions are sufficient or are there other legislative changes legion would like to see congress enact in some with the changes which have been enacted they've all been enacted very recently and we're seeing promising signs for example with what beginning to do with improving electronic communication and making forays into the solutions they're showing promising signs but it's still very very early to determine how overall effective those will be as i've stated before it would be beneficial to work with the changes that are creating improvements but we do we don't want to just change the set of tools that continue to operate within the same system if if you continuing to make the same problems but doing it electronically that doesn't make it any better than if you're making the problem if you're making the same mistakes and doing them on paper in terms of legislative solutions which could be brought forward already up for consideration as we mentioned in our testimony changes to the section eleven fifty four which covers veterans currently covers veterans who engage in combat and proving the occurrence of incidents that are consistent with combat and the expansion of it to combat zones as we recognize the non linear battlefield to the modern warfare and that the documentation of all such incidents for all soldiers not just soldiers who have infantry crossed rifles and can get a combat infantry badge not just soldiers who are wounded and receive a purple heart which makes things obvious but all the soldiers who are deployed to combat zones and experience these incidents which are sometimes difficult to document so continuing to work towards that legislation and past solutions on that front would be a great help in reducing a lot of the workload on because it would reduce a lot of their burden for over developing they would be able to grant that one point of a case and move on and they wouldn't spend a lot of time needlessly develop sir and mr prohack and once again thank you for your testimony and your service and it sounds like nobody from v a mentioned to you that you could file a claim even though you were in treatment for over two years you mr jackson i'm interested in the provisional claims processing proposal that you mentioned in your testimony could you elaborate on how it would work practically by walking us quickly through the first fix what it does is by just timing what you're doing is you're allowing existing information to be used for a provisional rating the veteran then if he or she decides that that rating is not what they think is sufficient then they can continue the process that they normally would what the goal of the provisional proposal that gerri is created is to is to get claims new claims through the system quickly allowing the workforce to work on the backlog it's it's it's it's something that is it's not going to be a permanent  you all have very helpful things to offer today but following up on the question that was just asked by the chairman on the provisional suggestion what recourse would have better have under this program if their condition worsens and they wanted an increased reading between the time they were initially rated in the final four years later the way the proposals are written currently that once once the  received a provisional rating and they're going to have to wait for the for your point so they'll get the provisional rating they either accept it if they accept it then they do a full development and an evaluation at the for your point and it if it's determined that there's more needed then obviously that will come out at that time converse if it turns out that the evidence shows that perhaps the provisional reading was a little bit high then that's going to bear out as well but once the the veteran decides under the way the proposals written once the veteran decides to take the provisional rating they'll have to wait to the for your point to to change to have a change and it does not stop the veteran let's say that the injury that they have received the initial injury becomes worse it does not stop that veteran from being able to to to show that the injury has worsened or or a disease has worsened in that four year period of time conversely if could they see their compensation reduced and go in the other direction at the end of the four years well that would all yeah that would always be a possibility it would be a possibility that the initial  rating might have been too high and then that would have to be lowered obviously with the full developmental work of the evaluation so it's conceivable that the veteran could could see the benefit  to improve the quality we travel and do reviews of regional offices and you can see a claim that gets brokered out that has say four issues and they take one small issue that's in it rate and defer the other three issues and send it back t original office will they get a work credit for that where it's been brokered but it's been sent back in the work isn't actually getting done in some cases it is and the idea of pushing a workload to places that can accept it better is not in theory a bad thing but it needs to be executed well and one of the things that i spoke to in my oral remarks is the working towards a system where you are counting credit where you are working credit for cases that have been done properly cases that have been done completely cases where it was done right the first time because that saves the v a from having to continue to process cases that are bouncing back and forth in the system and so that's what i would say go to that principle of regardless of where you're sending the claim get it done right the first time and it won't bounce around and mr deploy specifically would reward the decision making that's done right the first time which is i think what we're all after it was proposed in the past another proposal at one point from n b a but there have been other things that are similar to change the way that they count work credit and in the in the short term obviously there would be a certain amount of upheaval with this and it would be difficult to measure as any sort of new system where work credit would not be granted in till the case was finally decided and therefore if you were just passing along a case that's going to get remanded going to have missing details and get appealed you're not setting yourself up for success because you're setting up a case that's going to take a long time to give you work credit whereas if you do the details right and make it impossible to be remanded because there aren't details such as that then you get the work credit faster because it's counted when the claim is finally decided ok thank you thank you all for being here and like the chairman said thank you for your patience as well thank you mr lambourn if i may i would just like to ask mr baker a question in listening to your testimony i'm reminded that over a year ago at a hearing we held on artificial intelligence dr randy miller chair of biomedical bioinformatics at the under bill university made similar observations about reducing the days to process claims by using clinical informatics which is what your imaging scanning would seem to do have you also consider the idea that the scanned image should also be converted into a standardized electronically electronically process simple format what is the feasibility of implementing the proposed centralized information system that you mentioned in your test well mr chairman if you're talking about are we suggesting if you use something like an image scanning center would you do pages on the computer the feasibility of that i'm afraid i just i don't have the expertise i don't know where it is in their development you know if they can do something like that as i understand it there's a lot of companies out there and processes out there that can capture that sort of data i don't know where v a is with that technology thank you and your plan also calls for a reduction in time from one year to one hundred one hundred eighty days of the time that a veteran to make an appeal but then allows them the opportunity to ask for an extension other insurance programs have restrictions that to not allow an appeal after the due date are there circumstances under which you could see a case being closed and an appeal disallowed should there be a limitation on the number of times that are better and can appeal the same conditions without new evidence i could see where one could get closed in disallowed it they allowed the six months to run out and they did not request an extension and they didn't they couldn't show any cause as to why other people should be equitably told that would be no different than the people running out in excess of one year point right now only right now they upfront but when you're providing a couple extra benefits that a lot of people are going without right now which is the extension of the equitable tolling we think that's more than fair and it's still six months we're talking about the average question should there be a limitation on the number of times a veteran can appeal the same condition without new evidence has a process now a lot of people get confused if you if you reapply for the same thing you've been denied for and you don't have any new evidence what you normally get is you will get as a decision saying you haven't presented you evidence your claim is not reopened however that in and of itself can be appealed all the way up the courts so it is in effect a claim in the system the claim is an appeal to reopen the claim during the appellate process that could be decided in favor of the veteran and goes all back down the beginning just to be reopening the actual issue decided line when you start taking away rights at some point where they had no evidence whatsoever that's kind of what they do now that you can appeal that decision just like you to feel anything else thank you very much and  department of defense appeared at one of these hearings they described their p t s d approaches relying on the opinion of the medical examiner which is what it seems you are suggesting instituted a disability evaluation system close enough decision review officer of the cleveland regional testifying on behalf of the american federation of government employees welcome to both of you your complete written statements are part of the hearing relating to the needs of veterans with disabilities provide information relating to the character of disability arising from service in the armed forces provide an ongoing assessment of the effectiveness of  then when you could just take care of them the first time around i have great respect for the process but every time i ask questions i don't know how to narrow it veterans benefits ministration u s department of veterans affairs bradley mays director of compensation and pensions service for the v a scott cragg executive director and program manager virtual lifetime electronic record program office of policy planning for the u s department of veterans affairs and paul tibbets m d deputy chief information officer and office of enterprise development i think we have the real stuff here and i thank you gentlemen for your patience and thank you for your service to our country to our veterans your complete statements our usual entered into the record and  just walk off your secretary welcome you're not recognized for five minutes thank you mr chairman members of the committee appreciate the opportunity to appear before you today to discuss the veteran's benefits ministrations disability claims processing and our efforts to improve processing in time and as i'm accompanied by mr brad mays director of our compensation pension service scott craig executive director and program manager for the virtual lifetime electronic record and dr  to chief information officer of the office of enterprise development as described in my written testimony a number of figures have been used to define the backlog of compensation and pension disability claims and let me say up front we do f the board of that earns appeals as well as miscellaneous actions such as correspondence i want to emphasize that processing all of these actions is important work that needs to be done in a timely matter but not all of these actions should be categorized claims to categorize this work as all benefit claims as was described in several recent publications is an accurate representation of our pending claims inventory  categories rating and non rating workload the rating workload is composed of original and reopen claims for disability compensation and or pension workload as the measurement for the pending claims inventory because  is waiting for an entitlement decision for service connected disability compensation or non survivor pension benefits the non reading workload includes actions that do not require rating decision such as eligibility determinations or income adjustments this portion of the workload varies during the year due to the cyclical nature of the income and eligibility verification process associated with the pension workload pending claims inventory includes all rating related claims whether the claim has been pending for a few hours or for a much longer period of time depending claims inventory is dynamic since completed rating related claims are removed from the inventory while new rating related claims are added on hundred thirty nine thousand three hundred thirty three reading claims pending for more than one hundred twenty five days or thirty six point seven percent of the pending in the tory during fiscal year zero nine has made progress in reducing the number and percent of pending greater than one hundred twenty five days at the end of may we were at one hundred thirty four thousand six hundred twenty six or thirty three point five percent of the inventory that was pending greater than hundred twenty five days our production or number of claims completed has increased by nine point three percent as compared with the same period last year however fiscal year date ending may of two thousand and nine the number of rating claims received has increased thirteen point five percent as compared to the same period last year are pending reading claims inventory has increased this year by approximately twenty two thousand to a total foreigner in two thousand as of may to may thirty first although the pending claims  inventory has increased we believe this is mainly due to many outreach efforts conducted which were targeted to specific groups of veterans such as mailing letters to veterans receiving treatment at v a medical centers for type two diabetes who served during the vietnam war and conducting outreach to separating service members at discharge locations around the world despite increases in our pending inventory timeliness is improved to school year to date and in may of two thousand and nine the average days t complete a rating reality claim has decreased two hundred sixty one point eight days as compared to one hundred seventy eight point nine days during the same period last year taking steps to decrease the pending inventory further we have hired nearly forty two hundred new employees since january two thousand and seven and believe that these employees will continue to make progress in delivering more quality decisions in a timely manner in addition conducting a pilot in little rock arkansas as a result of a recent this includes deploying imaging and enhanced electronic workflow capabilities enterprise content and correspondence management services and integrating those services with our modernized payment system anticipates that the release of the initial hardware and software  management workforce planning and organizational learning strategies to ensure that is well positioned to take best advantage of the technology solutions being proposed stablished a business transformation lab in providence rhode island to serve focal point for convergence a process reengineering in technology assuring that the service of the reason optimized and best practices are developed and deployed throughout the v a is also working to create a streamlined electronic communication method with stakeholders such as the that will capture servicemen or veteran information from accession to the military service this will include all information necessary to provide medical care services benefits and compensation to the veteran eligible family members or eligible the beneficiaries department have been successful in formulating a plan to achieve the follow operability previously mentioned for the prevention of clinical care by the september two thousand target date as part of this million pieces of paper a year this year so far the d o d failed to transfer one point six million pieces of paper to according to the report twenty percent of paper records are lost when records were finally shipped to resulted in one thousand two hundred reeducation xina year furthermore this represents about thirteen percent or forty thousand veterans being wrongly denied this is a huge burden placed on v i'll take that mr chairman first of all we do rely on department of defense records to adjudicate claims for service connected disability compensation because we we need as i've said before in previous testimony we need that current disability or disease on evidence of an injury or onset of disease while on active duty and then the nexus between the two so that forms the basis for compensation so we we do need those records are important to us i would say that the efforts underway that have that's what we're working hard towards i think that's the mandate from the president and clearly it's a high priority for the highest priority for for both secretaries we share that priority with you to be decided have committed suicide i don't have an answer for that when you say waiting for a claim to be decided you're saying that from the time that they file the claim and then some time before they committed suicide i don't have an answer  i don't know if that's something that you to the department keeps track of or if you i mean i think i heard you mention the one hundred twenty five day mark is something that you consider a target  so might be useful to keep track of how many veterans who were in the system and were passed one hundred twenty five days i mean we've already heard about the  of the essence in terms of processing claims that might reflect especially in this difficult economic environment that we're in today on a veteran's self esteem and his or her ability to image i'm not a doctor or a psychiatrist but i am suggesting that this is something that should be able to a question should be able to answer in order to find the right solutions to these problems and what i would what i would say is that you know i think that we believe that we have a responsibility to all veterans to provide a quality decision as quickly as possible that you know there are certain procedures that we have to go through based on the law which we've talked about in previous hearings and certainly we need to find the as possible and we're fully aware of that and certainly i think we owe that responsibility to all that thank you i understand and appreciate all the factors seems we've come up with so far as to create patches between alpha with some modest success but not necessarily a real solution what is the vision at this point for making the virtual lifetime electronic record  actually happen will it require both departments to use the same architecture or will two systems be able to function jointly and have a translator between them i think the questions are and i may ask got to weigh on this as well because he's the architect and while i have to know some of this i'm a reservist and a general surgeon from rural mississippi so i'm asking for the technical details however as we move forward in what we believe will be a what we describe as a service oriented approach although it may not be  identical but if we build services which can then be reviews then we can go in and pull from each other's database what we need so i don't know that i'm going to be able to say that it's going to be the exact program but we will have much better ability to see and move in between as you've mentioned right now we have been i think very successful i don't know that we've done enough of a absolutely there is within the v a architecture for multiple systems but what's important right now is that we establish the capability between the two agencies not only to share the format that is recognized as being a single record in fact the architecture should be able to allow that polling data from multiple sources multiple databases and multiple systems there's another part of the dealer that's also very important is to extend the ability for veterans and service members data beyond just the clinicians and those who provide those benefits so the architecture as we are multiple systems that are part of the overarching concept it's not only possible but it's also a positive way to move forward and a very good idea because as technology improves as methodologies improves we need to be able policy issues that we're trying to work through we're working with our office of general counsel i think that we would have something that we would have ready for concurrence within the next two to three weeks and then it has to of to valuate a person's performance during that first year and be able to if necessary take those types of actions without the employee having some of the program and their situations where after person been in the program for a while they're not progressing at the rate they should and at some point decision can be made that you know you're not going to progress for whatever for a lot of different reasons so i recruitment and currently i've been brought on active duty to try to manage this thing while a lot when i get started we will then have a total of fourteen government civilians s you know nominally the people who first set up the office said well we think that's about sixty some people get a little tied up on that number it's more a matter of we probably happens on a fairly regular basis when the r o sends a statement of case back to the veteran to complete the form we require the are to accompany it with a simple checklist called the duty to assist form what is the status of the implementation of this form and do you feel as if this too complicated for veterans and more can be done to assist them and seeking their  well we implemented we implemented that section back in december of two thousand and put out guidance to our regional offices that particular pilot i believe involves four stations and so at those four stations when we receive an application for benefits that meets the criteria established and in the law when we send out our notice letter which is required again by statute what we do is we put what evidence and information it is required of the veteran in a checklist which is an attachment to  the to the notice letter that goes out so we have implemented that and we have also secured contracts support from the center for naval analysis to help us independently evaluate the effectiveness of to enhance that application to make it easier for a claimant to walk through that that application so we're trying to to meet those needs and improve that application process in the in the strategic plan that you're developing for paperless delivery of benefits i assume that there's a online version of this form for better to fill out right now today you can go online in and fill that application out that we're undertaking with the contractor an effort to make it more of a interactive guided process through the application so that it's easier it's more a question response scenario that then takes you into more detailed questions based on some of those responses so in essence you're beginning to see some rules technology even in the application process that's great that's really good to hear i understand that lean six sigma is a businessman  management strategy that was developed at motorola to find deficits and ways to improve operations the private sector is to readily make those changes what is the booz allen hamilton rationale that  can be that responsive to change making and did they supply an implementation plan for the recommendations the booz allen report focuses on files are being moved around the building because of the way the teams are set up that there's a lot of inefficiencies in the process and what they are recommending is a situation very similar to what  talked about where the file would go to individuals who work together on a on a called a team it's not each individual has responsibilities i know that you had some concerns about that and we do too and it's clear that each individual would have certain responsibilities but the fact that they're all working in the same location but first of all make it so that the files not going all over the building to you know as part of the assembly line but also that you have a situation where you would be able to have the different components of the process working together in terms of exchanging information and that kind of thing which will i think expedite the process and i think provide a better quality product now in terms of implementation it looks fine on paper but i think the question that you asked is the one we're asking which is will this actually work in our environment versus an industrial environment which is more widely known for and that's why we're looking at doing a pilot in little rock we are going through the some of the contracts all issues right now but it looks like we're going to be able to at least hopefully start that pilot in july and that will give us a lot more information about the actual application of some of these some of these principles thank you i understand that not every activity in your inventory is claims related some of it is related to adding dependents or answering letters and register as items of work and the workload how are those on other functions captured for employee work credits and how are they weighted  different team handle the non rating part of your workload or is everyone expected to vote a certain amount of time to all these tasks it really depends on what type of action it is there some of the some of the  nine rating work can be done in the triage team that comes in somebody is looking at it and try to determine where it goes some of the simpler actions are actually done right there on the team others are forwarded to the post germination it depends on  we always talk about in terms of what we consider inventory that's the four hundred thousand we have a nine rating which are the dependency changes the income adjustments and those types of things and there's about two hundred thousand of those is another hundred thousand of things that i call miscellaneous actions that were lumped into this million and those are things like a letter that a veteran would write in just asking a question about a general question about his benefits the publications that i referred to work counting that letter as a claim and i don't think under any definition that letter would be considered a claim certainly the non rating work although we don't consider it as part of the inventory that we talk about is very important work that has to be done  that all we're saying is that we prioritize getting the veteran on the rolls as his compensation claim and then after we've done that then we would talk about as a second priority adding a dependent to an existing record so just for the record what would you say as a number for what you consider to be a backlog and i would say that our backlog is right now and again i'm going to give you the number i gave you was about one hundred fifty thousand one hundred forty thousand at our backlog and that is based on the rating inventory of cases that are over one hundred twenty five days now if you want to add the nine rating frankly i believe we should be doing on reading cases in about ninety days so if you said well i think that your nine rating should be considered as part of your inventory as well as your rating th after a protracted process ninety percent of veterans disability claims are ultimately granted at least in part given that so many claims are eventually worded couldn't reduce its backlog and  process for the better and by assuming that the veteran's lay statement is accurate and consistent with time place and circumstance and as long as there is a diagnosis grant the benefit i'll give you my personal reaction to this and and i think when i looked at when i looked at that way i think it really calls into question whether that's a good policy or not if i could ask you one more question mr wal ten percent because star personnel did not identify errors that affected veterans in title months of benefits it also found that the excluded up to one hundred twenty six thousand broker claims those claims assigned from one regional office but to one regional office but sent to another for development or rating from the star review the projected thirty one percent of these brokered contained errors affecting veterans benefits which resulted in an actual sixty nine percent overall accuracy accuracy rate for v a which is far short you know if your goal of ninety percent accuracy clearly these errors add to the  report for instance has it begun to sample broker claims have you begun to sample broker plans something that itself identified as a need in two thousand and seven have there been additional staff hired to deal with this or specific training requirements my answer to that is basically i agree that we all agree that broken work should be sample i don't necessarily agree with  audit i believe that we begun calling cases in there brokered and i think with the number of cases that we have it is important to get an accurate representation of what that quality rate is so we are doing it now having been trained how many per month are coming online working independently it's hard to say because the they weren't hired on even the words we didn't hire say two hundred every month there were some months that we hired as many as five hundred there were other months that we hired a lot less than that a lot of it was trying to be able to schedule all the training because we felt it was really important that every new employee go to centralize training within a certain number of weeks of when they start so trying to get space available we added space to our training academy took a little while for that to be ready off the top of my head i can't get you that answer but i can certainly  time frame for meeting those goals you think you'll meet the september two thousand and nine goal for a fully interoperable electronic health records system we believe that the the goal which is to get  the electronic health record required for the clinical care as defined by our clinicians the so called i said we believe we will meet that now watching that closely there's still some risk claims as they are discharged from active duty that should be much easier since both departments are operating computerized capable of operating a paperless environment so so hopefully the two will be join the golden spike in the middle of the transatlantic i mean the transcontinental railroad would be driven and we will celebrate the day when that handoff is happening for our our current generation of veterans regarding veteran who has a new problem or a change in their claim or an increased application for an increased percentage rating or a case that requires some new are all that work is electronic and we're at the point now where we've been doing it for a long enough period of time that we're getting reopen claims from some of the people that we did their original claims electronically and we're doing those reopen claims electronically so as that group of people gets larger and more time to get more reopen claims that will continue to do an electronic environment we do have some technical limitations in terms of how much work we can put in the current system the virtual v a system was developed a long time ago relatively long time ago and there are some some issues with the capability of it in terms of volume that's not the permanent solution to our where we're going to be in two thousand and twelve but it does limit us to a certain extent on how much we can do right now in terms of your question about how we would progress once we get to tw twelve i would tell you that that's the kind of thing that we are working on right now kind of thing we're working with alan on as our one of our consultants to try to figure out now that we're going to have this knowledge of what's the best way to use it really what it needs to be to handle that additional volume that's an additional challenge to rectify that that requires some engineering money acquired german actions etc etc and it also requires that we become smart enough to get ahead of the curve so that our ability to anticipate transaction volume growth in the future is better than our ability to anticipated in the past and that that requires strengthening of our knowledge skills and abilities with the capacity planning itself so facilities in the united states we are extremely successful at it that's not to say it's perfect that's not to say that there's not room for improvement as a factory where it's changing that health information before moving into   understandable and we probably would all agree that the health information is the most important thing for veterans specially those suffering serious injuries would agree with that but the this is an evolving piece of work i would be looking for on the committee look forward to seeing the booz allen report as soon as you can share it with us and if we have any further questions we will submit them in