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ADJUDICATING VA’S MOST COMPLEX DISABILITY 

CLAIMS: ENSURING 

QUALITY, ACCURACY AND CONSISTENCY ON 

COMPLICATED ISSUES 

HEARING 

BEFORE THE

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND 

MEMORIAL AFFAIRS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

Wednesday December 4, 2013 

Serial No. 113–47 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://www.house.gov/reform 


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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Chairman 

DOUG LAMOBORN, Colorado 

GUS M. BILIRAKIS, Florida, 

DAVID P. ROE, Tennessee 

JEFF DENHAM, California 

BILL FLORES, Texas 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MARK E. AMODEI, Nevada 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

PAUL COOK, California 

JACKIE WALORSKI, Indiana 

MICHAEL H. MICHAUD, Maine, Ranking 

Member 

CORRINE BROWN, Florida 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

ANN KIRKPATRICK, Arizona 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

TIMOTHY J. WALZ, Minnesota 

Jon Towers, Staff Director 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

JON RUNYAN, New Jersey, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

MARK AMODEI, Nevada 

PAUL COOK, California 

DINA TITUS, Nevada, Ranking Minority 

Member 

BETO O’ROURKE, Texas 

RAUL RUIZ, California 

GLORIA NEGRETE MCLEOD, California 

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. 


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C O N T E N T S 

Page 

December 4, 2013 

Adjudicating VA’S Most Complex Disability Claims: Ensuring Quality, Accuracy And Consistency On Complicated Issues 1 

OPENING STATEMENT 

Hon. Jon Runyan, Chairman 1 

Prepared Statement ......................................................................................... 5 

Hon. Dina Titus, Ranking Minority Member 3 

Prepared Statement ......................................................................................... 7 

WITNESSES 

YN1 Lauren Price, USN (Ret.) Public Affairs Representative Veteran Warriors 

Oral Statement ................................................................................................. 8 

Prepared Statement ......................................................................................... 10 

Accompanied by: 

MMCS James Price, USN (Ret.) Senior Logistics Chief Veteran Warrantors 

Ms. Bettye McNutt, Surviving Spouse 

Oral Statement ................................................................................................. 14 

Prepared Statement ......................................................................................... 16 

Accompanied by: ...............................................................................................

Glenn R. Bergmann, Esquire, Bergmann & Moore, LLC 

Mr. Sherman Gillums, Associate Executive Director for Veterans Benefits 

Paralyzed Veterans of America 

Oral Statement ................................................................................................. 26 

Prepared Statement ......................................................................................... 29 

Ronald Abrams, Esquire, Joint Executive Director National Veterans Legal 

Services Program 

Oral Statement ................................................................................................. 32 

Prepared Statement ......................................................................................... 34 

Mr. Zach Hearn, Deputy Director for Claims, The American Legion 

Oral Statement ................................................................................................. 41 

Prepared Statement ......................................................................................... 43 

Mr. Tom Murphy, Director Compensation Service Veterans Benefits Administration, U.S. Department of Veterans Affairs 

Oral Statement ................................................................................................. 53 

Prepared Statement ......................................................................................... 55 

Accompanied by: 

Ms. Edna MacDonald, Director of the Nashville Regional Office Veterans 

Benefits Administration, U.S. Department of Veterans Affairs 

Ms. Sondra F. McCauley, Deputy Assistant Inspector General for Audits 

and Evaluations Office of Inspector General, U.S. Department of Veterans 

Affairs 

Oral Statement ................................................................................................. 62 

Prepared Statement ......................................................................................... 63 


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IV 

Accompanied by: 

Mr. Brent Arronte, Director of San Diego Benefits Inspections Division 

Office of Inspector General, U.S. Department of Veterans Affairs 

APPENDIX 

Statement by Jeffrey C. Hall, Disabled American Veterans ................................ 81 

Statement by Patricia Driscoll, The Armed Forces Foundation .......................... 87 

Tragedy Assistance Program for Survivors ........................................................... 88 

Statement by Ms. Sulin Schafer, Spouse of Veteran Errick Schafer .................. 92 

Veterans and Military Families for Progress ........................................................ 93 00


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ADJUDICATING VA’S MOST COMPLEX DISABILITY CLAIMS: ENSURING QUALITY, ACCURACY AND CONSISTENCY ON COMPLICATED ISSUES 

Wednesday, December 4, 2013 

HOUSE OF REPRESENTATIVES

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND

MEMORIAL AFFAIRS

COMMITTEE ON VETERANS’ AFFAIRS

Washington, D.C. 

The subcommittee met, pursuant to notice, at 3:04 p.m., in Room 

334, Cannon House Office Building, Hon. Jon Runyan 

[chairman of the subcommittee] presiding. 

OPENING STATEMENT OF CHAIRMAN JON RUNYAN 

Present:Representatives Runyan, Lamborn, Bilirakis, Titus, 

O’Rourke, and Negrete-McLeod. 

Also Present: Representatives Miller, and Michaud. 

Mr. RUNYAN. Good afternoon, everybody, and welcome. This oversight committee of the Subcommittee on Disability Assistance and 

Memorial Affairs will now come to order. 

Throughout the past year, Members of the subcommittee as well 

as the full committee have heard from VA representatives on various initiatives that have been instituted in order to fulfill the secretary’s goal on disability benefits claims for 2015. 

VBA implemented national initiatives within its regional offices 

including challenge training, quality review teams, skill certification testing, and simplified notification letter and fully developed 

claims. 

VBA also rolled out new technologies in the form of the Veterans 

Benefits Management System and several other electronic projects, 

as well as new processing models featuring segmented lanes and 

cross-functional teams. 

All along VBA indicated that significant support and training 

from VBA central office would be critical in this rollout. 

On top of these challenges, in April of 2013, VA announced that 

all cases pending in excess of one year would be completed by the 

conclusion of fiscal year 2013. 

Based on this new push, VA instituted many months of mandatory overtime for its employees. While there are general concerns 

on whether VA employees were able to issue decisions of high quality within the expedited time frame, there are also concerns that 

many of these oldest claims, in fact, were highly complex. 


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Regional office employees have previously reported that claims 

processors would pass over difficult cases and would routinely decide to call easy claims first in order to meet the production goals 

and maximize workload and workload credit parameters. 

Thus, it would stand to reason that many of these two-year-old 

and one-year-old claims decided in the past quarter constitute a 

challenging workload. 

And today we will hear about a focused issue which ties into the 

VA’s various initiatives and which highlights the clear necessity of 

uniform central office support and thorough employee training. 

Today’s focus is upon the complex claims that are routed to the 

special ops lanes at the regional office to include large multi-issue 

claims as well as traumatic brain injury, posttraumatic stress, military sexual trauma, and claims involving special monthly compensation just to name a few. 

While VA reported in November of this year that complex claims 

which take an excessive time to require special handling or only 

constitute ten percent of VA’s workload, these claims require highly 

competent, educated, and experienced attention. 

Importantly, decisions rendered in these complex claims often 

have tremendous effect on the lives of these veterans. 

Within VA’s strategic plan refresh for fiscal year 2011 through 

fiscal year 2015, the Department of Veterans Affairs noted no 

fewer than 30 times that VA’s strategic plan is results driven, and 

I quote, ‘‘We will be measured by our accomplishments and not our 

promises.’’ 

So today we want to hear accomplishments, what is going on in 

this high stakes, highly specialized claims processing environment, 

how has employee training focused upon the development of these 

issues, and what is working and what is not working. 

Also, we want to hear about the focused investigations of the 

VA’s Office of Inspector General who look at specific complicated 

claims on an annual basis within the regional office, reviews of VA 

OIG reports, as well as the recent veterans’ testimonials are alarming. 

In the past four years, at least 19 regional offices have been inspected by the OIG on a second instance. Of those, more than half 

saw a decrease in the claims processing accuracy with respect to 

traumatic brain injuries. This means that the reports indicate that 

VA’s OIG’s second visit to the ten regional offices evidenced more 

errors than the initial visit did. 

With respect to temporary 100 percent disabled claims, while improvements have been made on half of the offices, inspectors still 

could not process 50 percent of these claims correctly on their second inspection. There is still no other word for this but unacceptable. 

At this time, I would like to welcome our witnesses. We will have 

three panels here today. Currently seated are the participants of 

panel one. They include Ms. Lauren Price, United States Navy retired, accompanied by Mr. James Price, who is also United States 

Navy retired, who are here on behalf of Veteran Warriors. 

To Mr. Price’s left sits surviving spouse, Ms. Bettye McNutt, accompanied by Mr. Glenn Bergmann, partner at Bergmann Moore, 

LLC. 


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After the conclusion of panel one, we will hear from Mr. Sherman 

Gillums, the associate director for the Veterans Benefits with Paralyzed Veterans of America; Mr. Ronald Abrams, joint executive director for the National Veterans Legal Service Program; and Mr. 

Zach Hearn, deputy director for Claims with The American Legion. 

Finally, the third panel, we will hear from Mr. Tom Murphy, director of Compensation Services with the Veterans Benefits Administration, accompanied by Ms. Edna MacDonald, director of the National Regional Office. 

The third panel will also host Ms. Sondra McCauley, deputy assistant inspector general for Audits and Evaluations with Office of 

the Inspector General, U.S. Department of Veterans Affairs, who 

will be accompanied by Mr. Brett Arronte, director of San Diego 

Benefits Inspections Division. 

Additionally, the hearing record will include written statements 

from Disabled American Veterans, the Tragedy Assistance Program 

for Survivors, and Ms. Sulin Schafer, wife of air force veteran, 

Errick Schafer. 

With those instructions complete, I thank you all for being here 

today. 

I now yield to the ranking member for her opening statement. 

OPENING STATEMENT OF THE HON. DINA TITUS, Ranking 

Minority Member 

Ms. TITUS. Well, thank you, Mr. Chairman, and thank you for 

holding this important hearing. 

I would also like to thank the witnesses you mentioned who are 

here today for their time and trouble to come and share information with us. 

First, I want to applaud the VA for reducing the benefits backlog 

by 34 percent since March of 2013. We hope that the VA can maintain this momentum and we are optimistic. We want to end this 

decades long backlog and we are moving in that direction. 

Our numbers indeed show that the VA is on track to reach the 

secretary’s goal by 2015, so I would ask you to relay a message to 

the people who work for the VA and tell them thank you for their 

efforts and to please keep up the good work. 

As the VBA continues to work through this transformation, it is 

very important that we are working together towards solutions 

that will improve the processes of providing benefits to veterans, 

benefits that they have earned, and we want them to be provided 

in the most timely and efficient manner possible. 

So we need to be forward looking so we can address the next 

issues rather than just the problems from the past. We want to be 

able to anticipate what is coming down the road so we do not create any new backlog issues. 

Earlier this year, our subcommittee worked on a package of bills 

that are forward-looking and I believe would help the VA provide 

better services to our veterans. The House has passed many of 

these measures. They were bipartisan measures, and I hope that 

the Senate will soon take them up and send them on to the President for his signature. 


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One of the bills specifically was my bill, Pay As You Rate, which 

I think is appropriate to today’s topic as we look at complex cases 

that have more than one issue involved with them. This bill would 

require the VA to pay veterans as each of their individual medical 

conditions is completed. 

Such an approach would result in veterans throughout southern 

Nevada—my district—and the country in receiving their payments 

in a more timely manner rather than waiting until the entire case 

is adjudicated which can be very complex. As we will hear, they 

can get pieces done as they go along. 

Additionally, it seems that such an approach would offer the VA 

better workload management options where some of the best VA 

regional offices could specialize on those medical conditions which 

have proven to be more challenging and more complex such as military sexual trauma and traumatic brain injury. 

My colleague, Ranking Member Michaud, has introduced a bill 

that would provide veterans with better decisions in a timely manner by doing just that and look forward to seeing that move forward. 

I am proud to say that we seem to be making progress that is 

reducing the backlog, but there is still some clunkiness in the operations and in the effectiveness or lack of effectiveness. 

For example, I am concerned that the VA may be oversimplifying 

some of the more complicated and complex medical conditions. The 

VA has essentially broken down the coding system with nearly a 

thousand different medical conditions and endless variables into 

just three lanes, easy, medium, and hard. 

That seems a pretty simplified way of looking at all of these different variables. And when you define complexity as just the number of medical conditions in a claim, I am not sure that is an adequate way of looking at it. 

It is important to note that the number of conditions does not 

necessarily dictate the complexity of the entire claim. This method 

of evaluating complexity made sense in a paper processing world. 

But as we look forward now to best practices, I believe complexities 

should be measured not just by the number of conditions but rather by the complexity of evaluating and paying for the medical conditions that are under consideration. 

It is important that the VA look within the current system across 

all 56 VA regional offices to determine what are best practices for 

assigning that complicated work. I believe that the VBA can work 

with VBMS to broker work from one station to another to ensure 

that the best employees are working on the most challenging cases. 

This subcommittee—and I thank the chairman for his work on 

this and for his cooperativeness with our side of the aisle—and the 

VA share a common goal and that is ensuring that our veterans 

receive the best benefits in a timely fashion. 

So I think we can continue to work together as a committee with 

the VA to develop these tools and best practices. And I look forward to hearing your testimony and seeing what options may be 

available to us as we move forward. 

With that, I yield back. Thank you, Mr. Chairman. 

Mr. RUNYAN. Thank you, Ms. Titus. 


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PREPARED STATEMENT OF THE HON. JON RUNYAN, Chairman 

‘‘Adjudicating VA’s Most Complex Disability Claims: Ensuring 

Quality, Accuracy and 

Consistency on Complicated Issues.’’ 

December 4, 2013 

Good afternoon and welcome everyone. This oversight hearing of 

the Subcommittee on Disability Assistance and Memorial Affairs 

will now come to order. 

Throughout the past year, the Members of this Subcommittee, as 

well as the Full Committee, have heard from VA representatives 

on various initiatives that have been instituted in order to fulfill 

the Secretary’s goal on disability benefits claims for 2015. 

VBA implemented national initiatives within its regional offices, 

to including Challenge Training, Quality Review Teams, Skills Certification Testing, Simplified Notification Letter, and Fully Developed Claims. 

VBA also rolled out new technologies in the form of the Veteran 

Benefits Management System and several other electronic projects, 

as well as a new processing model featuring segmented lanes and 

cross-functional teams. All along, VBA indicated that significant 

support and training from VBA central office would be critical in 

this rollout. 

On top of these changes, in April of 2013, VA announced that all 

cases pending in excess of one year would be completed by the conclusion of Fiscal Year 2013. 

Based upon this new push, VA instituted many months of mandatory overtime for its employees. 

While there are general concerns on whether VBA employees 

were able to issue decisions of high-quality within the expedited 

time-frame, there are also concerns that many of these ‘‘oldestclaims’’ were, in fact, highly complex. 

Regional Office employees have previously reported that claims 

processors would pass over difficult cases, and would routinely decide so called ‘‘easy’’ claims first in order to meet production goals 

and maximize workload credit parameters. Thus, it would stand to 

reason that many of these two-year old and one-year old claims, decided in the past quarter, constituted a challenging workload. 

And today we will hear about a focused issue, which ties into the 

VA’s various initiatives, and which highlights the clear necessity of 

uniform Central Office support and thorough employee training . . . 

today’s focus is upon the complex claims that are routed to the special-ops lanes at the Regional Offices, to include large multi-issue 

claims, as well as traumatic brain injury, post-traumatic stress, 

military sexual trauma, and claims involving special monthly compensation, just to name a few. 

While VA reported in November of this year that complex claims, 

which take extensive time or require special handling, only constitute 10% of VA’s workload, these claims require highly competent, educated, and experienced attention. Importantly, decisions 

rendered in complex claims often have a tremendous effect upon 

the lives of these veterans. 

Within VA’s ‘‘Strategic Plan Refresh’’ for Fiscal Year 2011 

through Fiscal Year 2105, the Department of Veterans Affairs 


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noted no fewer than THIRTY times that VA’s strategic plan is ‘‘results driven,’’ and I quote, ‘‘We will be measured by our accomplishments, not by our promises.’’ 

So today, we want to hear accomplishments——what is going on 

in this high-stakes, highly specialized, claims processing environment? How has employee training focused upon the development of 

these issues? What is working? What is not working? 

Also, we want to hear about the focused investigations of the VA 

Office of Inspector General, who look at specific complicated claims 

on an annual basis within the Regional Offices. Reviews of VA OIG 

reports, as well as recent veteran testimonials, are alarming. 

In the past four years, at least nineteen Regional Offices have 

been inspected by OIG on a second instance. Of those, more than 

half saw a decrease in claim processing accuracy with respect to 

Traumatic Brain Injuries . . . This means that the reports indicate 

that VA OIG’s second visit to ten Regional Offices evidenced more 

errors than the initial visit. 

With respect to temporary one-hundred percent disability claims, 

while improvements were made, half of the offices inspected still 

could not process 50% of these claims correctly on their second inspection. There is no other word for this, but simply ‘‘unacceptable.’’ 

At this time, I would like to welcome our witnesses. We will have 

three panels today. 

Currently seated include the participants in Panel One. They include Mrs. Lauren Price, United States Navy, Retired, accompanied 

by Mr. James Price, also United States Navy, Retired, who are 

here on behalf of ‘‘Veteran Warriors.’’ 

To Mr. Price’s left sits surviving spouse Ms. Bettye McNutt, accompanied by Mr. Glenn R. Bergmann, Partner at Bergmann & 

Moore, LLC. 

After the conclusion of Panel One, we will hear from Mr. Sherman Gillums, Associate Executive Director for Veterans Benefits 

with Paralyzed Veterans of America; Mr. Ronald Abrams, Joint Executive Director for the National Veterans Legal Services Program, 

and Mr. Zach Hearn Deputy Director for Claims with The American Legion. 

Finally, in the third Panel we will hear from Mr. Tom Murphy, 

Director, Compensation Service, with the Veterans Benefits Administration, accompanied by Ms. Edna MacDonald, Director of the 

Nashville Regional Office. 

The third Panel will also host Ms. Sondra F. McCauley, Deputy 

Assistant Inspector General for Audits and Evaluations with the 

Office of Inspector General, U.S. Department of Veterans Affairs, 

who will be accompanied by Mr. Brent Arronte, Director of San 

Diego Benefits Inspections Division. 

Additionally, the hearing record will include written statements 

from Disabled American Veterans, the Tragedy Assistance Program 

for Survivors, the Armed Forces Foundation, and Ms. Sulin 

Schafer, wife of Air Force veteran Errick Schafer. 

With those introductions complete, I thank you all for being with 

us today and I now yield to our Ranking Member for her opening 

statement. 


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PREPARED STATEMENT OF DINA TITUS, Ranking Minority 

Member 

Thank you, Mr. Chairman, for holding a hearing on this very important topic. I also want to thank the witnesses for their attendance this morning. 

First, I would like to applaud the VA for reducing the benefits 

backlog by 34 percent since March 2013. We hope that the VA can 

maintain their momentum and end the decades old backlog. Our 

numbers show that you are on pace to indeed reach the Secretary’s 

goal by 2015. I ask you to relay this message to the workforce - 

keep up the good work. 

As VBA continues to work through its transformation, it is important that we are working towards solutions that will improve 

the processes of providing veterans the benefits they have earned, 

in the most timely and efficient manner possible. We should be forward thinking to address the next issues, not just the problems 

from the past. 

Earlier this year our subcommittee worked on a package of bills 

that are forward looking and would help the VA provide better 

services to veterans. The House has passed many of these measures, and I hope the Senate will soon send them to the President 

for his signature. 

Specifically, my bill, the Pay As You Rate Act, would require the 

VA to pay veterans as each of their individual medical conditions 

is completed. Such an approach would result in veterans throughout Southern Nevada receiving payments in a timelier manner for 

their simple medical conditions. 

Additionally, it seems that such an approach would offer the VA 

better workload management options where some of the best VA 

Regional Offices could specialize on those medical conditions that 

have proven to be more challenging such as Military Sexual Trauma and Traumatic Brain Injury. My colleague, Ranking Member 

Michaud, introduced a bill that would provide veterans with better 

decisions in a timelier manner by doing just this. 

While I am proud to say we finally seem to have a system that 

is reducing the backlog, it is still clunky in its operational effectiveness. 

I am concerned that the VA may be oversimplifying some of the 

more complicated medical conditions. The VA has essentially broken down a coding system with nearly a thousand medical conditions and endless variables into three lanes—easy, medium, and 

hard. Complexity is usually defined at the VA as the number of 

medical conditions in a claim. 

It is important to note however, that the number of conditions 

does not necessary dictate the complexity of the entire claim. This 

method of evaluating complexity made sense in the paper processing world. As we look for best practices, I believe complexity 

should not be measured by the number of medical conditions in a 

claim but rather it should be measured by the complexity of evaluating and paying for specific medical conditions. 

It is important that the VA look within the current system, 

across the 56 VA Regional Offices to identify best practices for assigning complicated work. With VBMS, the VBA can instantly 


VACREP180 with DISTILLER
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broker work from one station to another to ensure the best employees are working on the most challenging cases. 

Our Subcommittee and the VA share a common goal – ensuring 

that veterans receive the benefits they have received in a timely 

fashion. I hope we can work together to find the best ways to utilize VBMS and other tools to meet this goal. 

Today’s hearing will explore these options, and I hope the VA 

will continue to work with us to implement many of our bipartisan 

ideas. 

I yield back. 

And with that, I ask unanimous consent that Chairman Miller 

and Ranking Member Michaud be able to participate in our hearing today. So hearing no objection, so ordered. 

At this time, I would welcome our first panel to the table. Your 

complete and written statements will be entered into the hearing 

record. 

Mr. and Mrs. Price, thank you for your service and for being here 

this afternoon. 

Ms. Price, you are now recognized for five minutes for your oral 

testimony. 

ORAL STATEMENT OF LAUREN PRICE 

Ms. PRICE. Thank you, Chairman. 

Chairman Runyan, Ranking Member Titus, members of the 

panel, Veteran Warriors asked me to express their gratitude for inviting ourselves as delegates to represent their views on the VA’s 

handling of complex claims and the challenges that are faced with 

those. 

Most of this panel has no idea who Veteran Warriors is. It is exactly what it sounds like. We are just a bunch of veterans, but we 

are specialists that come from a wide variety of fields and professions and bring in some cases decades of experience to the table 

and to the team. Our purpose is to deal with not just complex 

claims but with all issues relating to the VA’s functions. 

In particular, I am a combat vet. I served in the navy for seven 

years before I was medically retired. I contracted a terminal lung 

disease in Iraq. I also crushed both of my hands, parts of my hands 

and had to have my hands rebuilt. 

I am a hundred percent disabled. I can no longer work and my 

life expectancy now is down probably less than two years. My husband is my primary caregiver. I do not need anything from the VA 

any longer. 

My complicated claim took four years to adjudicate. Not once in 

that four years did I ever present one single piece of new evidence. 

The entire claim was submitted fully developed in its entirety before I was even discharged from the navy. 

I am here not to represent my claim or my issues. My husband 

and I are here to make sure that this panel and that everyone that 

will listen to us will understand that cases like my own and unfortunately like Mrs. McNutt’s are not isolated. 

I personally have dealt with at this time almost 1,000 cases just 

in the last six months of veterans and their spouses and children 


VACREP180 with DISTILLER
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who are dealing with complex claims that are being denied over 

and over and over again or being low-balled and zero rated. 

We are not a VSO. We are not a veteran service organization by 

any means. Our sole purpose is to work to try to get resolution to 

the manner in which the VA is conducting business. 

However, we are not going to sit here and lie to anybody. We are 

going to make sure that everyone understands that we do not agree 

with giving kudos to the VA. Over the last 12 years, the majority 

of the veterans that have come home and come into the system 

have filed complex claims. This was not a secret to the VA. They 

were well aware of what was coming home. 

You have a demographic of veterans that have spent multiple deployments, various hostile environments, come home. They are better educated now than they ever have been in history. They are 

also equipped with technology available that at a moment’s notice, 

they can get information to virtually any question they have regarding their benefits. 

The VA pictures this as a disaster waiting to happen because 

these are the veterans that are filing the complex claims. 

On November 7th, Secretary Shinseki took credit for reducing 

the backlog by one-third since March. We caution this panel and 

everyone involved with VA claims to don’t take that as gospel because there is a big part of the claims processing that they are not 

telling people. 

The most insignificant type of claim is not a medical claim. It is 

called a dependent status change. You get married. You have a 

child. You get divorced. Your child ages out. It is one document 

with one attachment, your marriage certificate, your divorce decree, what have you. 

Those go into claims. They are adjudicated right alongside someone who has a terminal lung disease or Agent Orange illnesses. 

Unfortunately, those claims, and we have been able to prove it to 

this subcommittee, those are the claims that they are closing and 

calling closed and adjudicated. And, unfortunately, that does help 

their numbers come down. 

We ask that every time that you get a new report on the VA’s 

numbers you look at it cautiously. You question the data. They are 

not sending in screen shots of their work product. They are creating reports. There is almost no transparency. No one in this room 

can just sit down and go look at all the numbers that the VA is 

working on that are being generated on a daily basis. 

Congress has never denied the VA a single penny for doing its 

job. The current budget, over $54 billion is being paid out to veterans in direct benefits. The balance of their budget that they receive right now is for administration of their business, but they are 

not doing business properly. 

I could sit here for hours and give you statement after statement 

after statement of egregious behavior, wrongful denials, or in some 

cases deliberate malfeasance. All we ask is that you continue to 

press this forward, you consider our mission which is to have a full 

overhaul of the Veterans Administration, completely reorganizing 

the way they are doing business, and demanding full and 100 percent accountability and repercussions for their actions. 


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Thank you again, Mr. Chairman, Ranking Member Titus, esteemed panel. We are extremely grateful for the opportunity to be 

here today to testify. We would be honored to take any questions 

from you. 

PREPARED STATEMENT OF LAUREN PRICE 

Chairman Runyan, Ranking Member Titus, and members of this 

Panel, VeteranWarriors expresses their gratitude for the opportunity to offer our views on the (Department of Veterans Affairs ) 

- VA’s ‘‘Most Complex Disability Claims’’ issues. 

The majority of this esteemed panel has never heard of 

VeteranWarriors. Please allow me to introduce you to our group. 

We are a very small group of Veterans and supporters, who have 

decided to be the ‘‘David’’ in taking on the ‘‘Goliath’’ of the Department of Veterans Affairs. Our sole mission is to convince every necessary entity that the VA is broken and in need of a full overhaul, 

such as the Internal Revenue Service was subjected to in the late 

1990’s, and assist us in making that reform a reality. We are internally funded and ask nothing for our efforts. However, our efforts 

to see the VA reformed will continue to press forward, until it is 

a reality. 

Our team has spent five (5) years reviewing every audit, investigation, Congressional testimony and media report, regarding the 

actions of the VA. We have taken thousands of statements from 

veterans and their families regarding everything from egregious 

delays or outright denials of rightfully earned benefits in claims 

processing to malpractice within the VA Health system. The culminations of that research lead us to create completely new working models of the major sectors of the VA. For obvious reasons, the 

concentration initially was on Veterans Benefits Administration 

side. 

We were invited here to today to provide our opinion on what 

could be the best method to assure that the VA processes complex 

claims, in a timely, accurately and in a consistent manner across 

the nation. To be brutally honest with this panel, there is currently 

no process that is in place, which will comply with those parameters. 

To illustrate the dysfunction within the category of complicated 

claims, we provide an analogy; 

You have a five year old desktop computer. It has a monitor, keyboard, mouse and a hard drive. For the last year, your computer 

will only come on about 50% of the time. You monitor works as 

does the keyboard and mouse – just the hard drive won’t boot up. 

You have had the ‘‘Geek Squad’’ look at, you have taken it apart, 

you have sent it to the manufacturer; every single person has told 

you that it is broken beyond repair and to buy a new computer. Instead of buying a new one, you buy a new monitor, you buy a new 

keyboard then you buy a new mouse. But your computer STILL 

only comes on 50% of the time. 

When is Congress going to buy a new computer? When are we 

going to force an overhaul of the VA? 

This analogy illustrates what is happening between Congress 

and the VA. For over thirty (30) years, the Government AccountVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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ability Office (GAO), the VA – Office of Inspector General (VA– 

OIG), the American Federation of Government Employees (AFGE) 

as well as countless Veterans Service Organizations (VSO) and veterans have testified, complained, reported to the media and asked 

for Congressional intervention regarding the absolute abysmal dysfunction that is the manner of doing business for the VA. 

To be clear, the term ‘‘dysfunction’’ is defined by Encarta Dictionary (and VeteranWarriors regarding the VA), to be, ‘‘An irregularity in the functioning of any part or system, (and) a characteristic of dysfunction of petty officialdom’’. 

Every veteran in this nation owes gratitude to the Veterans 

Service Organizations (VSO), for their ongoing efforts to assist with 

their claims and right the wrongs regarding VA decisions. As well 

as their continued presence here on Capitol Hill, representing 

them, in what the VSO’s believe to be the best interests of the veterans. 

However, VeteranWarriors is not officially a VSO. We never intend to be one. We will always do everything in our power to help 

a veteran or a family who reaches out to us. Our goal is not to placate or appease anyone, be it Congress, the officials of the VA or 

a VSO. We offer no apologies for our views on the actions of the 

VA. In other words, we are not here to lie to Congress and tell you 

everything is looking up and the VA is getting better at doing their 

ONLY mission. Unlike the VSO’s who have testified before us, we 

offer no kudos to any sector of the VA. In fact, we are here to tell 

you the plain truth – that the VA is irrevocably broken and the 

only way that all of the issues which Congress has repeatedly attempted to address, will be fixed, is by a forced overhaul based on 

VeteranWarriors new models. 

To address the purpose of this hearing, VeteranWarriors has reviewed current staffing, equipment, and financial resources that 

the VA is allocating to claims processing. The VA provides no specific information as to the resources dedicated to handling complex 

claims. We could find no official definition of complex claims or any 

numerical breakout regarding the handling of these claims. What 

we have found is that everyone from Undersecretary Hickey to the 

VSO’s has placed the blame for a large part of the backlog on the 

complex claims. Our lay understanding of a ‘‘complex claim is a 

claim which has more than 2 or 3 issues claimed by the veteran. 

For clarity, the lion’s shares of veterans coming into the system 

over the last 12 years have ‘‘complex’’ claims. When you have a demographic of veterans whose last decade has been spent with multiple deployments to various hostile environments, better educated 

veterans who know what their rights are and an age of technology 

whereby the veteran can readily obtain information, you have a 

recipe for what the VA considers to be disaster. 

The VA maintains that it is making headway in reducing the 

backlog of claims in its inventory. As recently as November 7, 2013, 

Secretary Shinseki took credit for reducing the backlog by over onethird since March 2013. What is being kept quiet, what is the dirty 

secret is that a disproportionate number of the complex claims are 

still awaiting adjudication or have been ‘‘closed’’ awarding the veteran a nominal rating on one or more of the minor issues. The primary issues the veterans are claiming are being either ‘‘ZERO 


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rated’’ or denied outright. The claims which the VA suggests are 

closed are the ‘‘simple’’ claims, ones with one or two issues. What 

the VA also does not share is how certain claims are classified thus 

significantly affecting the VA’s reported numbers, to the VA’s benefit. 

This panel must understand an important delineator when reading reports of the VA’s successes. The VA considers ANY type of 

claim that they have adjudicated and replied to the veteran as 

‘‘CLOSED’’. The important fact to remember is that 75% of the 

claims that are making their way to the Board of Veterans Affairs 

Appeals court are remanded for correction. These claims are only 

a small portion of the totality of claims decided by the VA. Too 

many veterans give up and refuse to keep fighting. So when the VA 

tells you they ‘‘closed a claim’’, it is imperative that the one be 

highly suspicious of the source of the data for the statement. 

One type of ‘‘claim’’ that the VA has used to reduce the backlog 

is ‘‘Dependent Status Update’’ claims. Getting married, got divorced, had a child, child ages out but then goes to college – these 

are all factors that are adjudicated under the ‘‘CLAIMS’’ category. 

Of course it would be really easy to profess success if you just got 

these claims adjudicated. The VA did this with one of our group – 

After a year of sitting without action, the VA finally adjudicated 

his claim for getting married. It took almost exactly one year after 

he filed the ‘‘FULLY DEVELOPED CLAIM’’ to add a dependent. 

Meanwhile, a veteran whose ‘‘complex’’ claim – filed while still on 

active duty and in compliance under the ‘‘Pre-Discharge’’ (formerly 

known as the Benefits Delivery at Discharge program), took four 

(4) years to adjudicate. That particular program was instituted 

jointly by the VA and the Department of Defense (DoD) to ‘‘ . . . 

minimize the waiting time for veterans to receive benefits and services . . . ’’ because the VA professes when filed before the member 

leaves active duty, the claimed issues are considered automatically 

‘‘service-connected’’. The veteran was forced to file four (4) Notice 

of Disagreements, a Formal Appeal (which the VA re-characterized 

as a Notice of Disagreement) and a second Appeal, which resulted 

in a Decision Review hearing. At which time, the officer awarded 

the veteran all the claimed issues retroactive to the end of active 

duty. However, the veteran still has not received Special Monthly 

Compensation even though all the claimed issues had transpired 

while serving as a convoy driver in Iraq for a year. 

Another Iraq combat veteran, has been denied for all ‘‘automatically service- connected issues’’, from day one. He filed his claim 

upon discharge from the military in 2009 and to date, has been denied for every issue claimed, in spite of mountains of medical evidence which include the VA’s own records. He is now being forced 

to file a Formal Appeal in the hope of every seeing any of his 

earned benefits. 

We could spend the rest of this panel’s time on the Hill this year, 

extrapolating on the thousands of cases which have come to our attention. We will not waste your valuable time by doing so. 

The issue of ‘‘complex claims’’ is the new reality for the VA. However, the VA refuses to adjust fire and accept it, manage it correctly, adjudicate them correctly and efficiently or even entertain 

the idea that their way of doing business with their sole customer 


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does not work. From the Secretary down to the lowliest janitor, no 

one is being held accountable, no one is accepting responsibility, no 

one is forcing the rank and file to abide by the laws, rules and policies that exist in managing these complex claims. Instead, the VA 

finds ways to manipulate the numbers, sugar-coat the malfeasance 

and explain away the $100 billion dollars per year it spends on administration of its business. 

Congress has never denied the VA any money for doing their job. 

But like a spoiled child, even getting what they want for every 

‘‘pilot program’’, new ‘‘initiative’’, increased manpower or bright and 

shiny new technology, they still want more without giving up anything. The VA does not have any ‘‘transparency’’ whatsoever. The 

veteran is forbidden from speaking with claims adjusters. The VA 

does not provide ‘‘screen shots’’ of their work product. Rather, they 

employ people whose sole purpose is to create reports that make 

the VA look good to Congress and the media. 

VeteranWarriors has developed a viciously more efficient, 

streamlined model of processing these ‘‘complex’’ claims, utilizing 

the resources the VA already has on board. No new money, resources, manpower or laws are needed to make proper adjudication 

of all claims, especially the complex ones, a reality. 

OUR proposed reality is one which provides for every veteran of 

every era, most especially those with complex claims. It is the right 

of every veterans claim to receive efficient, accurate and professionally managed benefits and services. This reality needs the support of every Congressional leader across the aisle today. So are we 

going to continue to ignore every expert that tells us the computer 

is broken and continue to throw good money after bad, or are we 

ready to buy a new computer . . . Are you ready to overhaul the VA? 

Thank you again Mr. Chairman, Ranking Member Titus and esteemed panel. We are truly grateful for the opportunity to present 

our opinions to you today. VeteranWarriors is humbled by the Congressional commitment and dedication to our veterans. 

VeteranWarriors would be honored to answer any questions by the 

panel for the record. 

Executive Summary 

The mission of VeteranWarriors is to be the catalyst which forces 

the necessary changes to the manner in which the Department of 

Veterans Affairs does business with its only customers...the United 

States Veteran. 

The VeteranWarriors testimony today, with regard to the manner by which the Department of Veterans Affairs manages complex 

claim, will introduce our position to Congressional leaders and provide clarity regarding Veterans Affairs practices and disciplines 

which are in our opinion, contradictory to the mission statement 

and very purpose of the Department of Veterans Affairs. 

VeteranWarriors’ primary areas of concern and recommendations 

remain static; 

* That complex claims are the standard rather than the exception and the VA has steadfastly refused to accept that these are the 

standard types of claims that veterans will submit now and continuing into the future. 


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* That complex claims are being pushed to the ‘‘back burner’’ in 

favor of ‘‘simple claims’’ in an effort to appease Congressional mandates, media pressure and veterans concerns. 

* That the VA Regional processing offices are foregoing handling 

complex claims in an effort to meet statistical requirements set out 

by the Secretary of the VA, as well as entice employees by creating 

a method to receive financial remuneration for the volume of 

claims ‘‘Closed’’, rather than focusing on accuracy and timeliness. 

* That Congressional leaders discontinue hearings, audits and 

investigations into the multiple issues of malfeasance, incompetence and dereliction of duty regarding the VA’s handling of 

claims, in particular complex claims that have been going on for 

decades. 

* For Congress to discontinue accepting the officials from the Department of Veterans Affairs manipulated data as factual, in the 

face of incontrovertible evidence to the contrary, especially without 

sworn testimony by the VA officials. 

* The recommendations to the panel include a complete overhaul 

of the Department of Veterans Affairs, specifically utilizing 

VeteranWarriors efficiency model. 

* Having identified the multiple methods by which the VA manipulates data presented, VeteranWarriors suggests that Congress 

has no other clear and present duty but to demand a full overhaul 

of the Department of Veterans Affairs. 

Mr. RUNYAN. Thank you, Ms. Price. 

And now we will hear from Ms. McNutt. Please begin your statement when you are ready. 

ORAL STATEMENT OF BETTYE MCNUTT 

Ms. MCNUTT. Thank you, Mr. Chairman, for holding today’s 

hearing on—— 

Mr. RUNYAN. Do you have the microphone on? 

Ms. MCNUTT. —complex VA claims. My name is Bettye McNutt. 

I am the widow of Ronald Adrian McNutt, Vietnam War veteran. 

Accompanying me today is my attorney, Mr. Bergmann, of 

Bergmann & Moore. 

The Subcommittee on Disability Assistance and Memorial Affairs 

invited me here today to discuss what has become my most complex and now 23-year-old claim for VA dependency and indemnity 

compensation. 

I am here for two reasons. First, I am here seeking justice for 

myself and for my family. I ask VA to correctly and promptly apply 

the law and grant my claim. Second, I am seeking justice for other 

widows and orphans of our Vietnam War veterans. 

In the audience today is my son who lost his father and his best 

friend when he was 12. Also in attendance today is my niece, Sandra Peterson, who is the daughter of a Vietnam War veteran who 

also died from Agent Orange poisoning. 

Mr. Chairman, I filed my claim in 1990. This same claim remains pending. I have waited 8,600 days of VA delays and denials. 

VA erroneously denied my claim seven times. For nearly 12 years, 

my claim sat idle at VA because VA did not respond to my notice 

of disagreement. 


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The Court of Appeals for Veterans Claims returned my claim to 

VA three times based on errors, errors conceded by the VA. I know 

that VA is waiting for me to die. Without immediate attention, my 

claim is destined to sit idle for several more years as I wait, hope, 

and pray for a resolution. 

My late husband, Ronnie, was born in Memphis, Tennessee on 

December the 31st, 1947. As a 19-year-old college student, he was 

drafted into the U.S. Army. Ronnie was deployed to the Vietnam 

War in 1968 and 1969. 

On September the 22nd, 1987 at the early age of 39, he died 

from an aggressive form of cancer leaving me a widow with a 

young son. His death came quickly from a cancer that invaded 

many parts of his body very rapidly. Ronnie died within five 

months. 

I brought a picture today of my Ronnie because this hearing 

today is honestly about my Ronnie. He died because of the Vietnam 

War and his service to his country. 

On his death bed, he told me about how he swam in rivers highly 

contaminated with Agent Orange. Ronnie told me stories about 

using discarded Agent Orange barrels for barbecue pits. 

First, VA has not contested that my husband served on the 

ground in Vietnam. Second, the law presumes veterans on the 

ground in Vietnam were exposed to Agent Orange. And, third, a 

medical expert provided the VA with two nexus medical opinions 

concluding that Ronnie’s cancer was as likely as not due to his exposure to Agent Orange in Vietnam. 

VA’s Jackson, Mississippi regional office made many, many mistakes. First, on more than one occasion, the VA applied the wrong 

legal standards to decide my claim. Second, VA ignored favorable 

medical evidence to my claim. And, third, the VA sought evidence 

to deny my claim. 

A lot was taken away from me 26 years ago and I have done the 

best that I knew how as a widow to provide for my son, Brandon. 

The impact of my husband’s death on my son was tremendous. 

Words cannot tell you. I have had emotional, physical, and financial distress. For me, I have suffered unimaginable grief from 

Ronnie’s death. For 8,600 days, words cannot express my suffering. 

Going without my VA benefits has meant coming home different 

occasions to a very cold and dark house because my utilities were 

turned off. It has meant receiving food and clothing from strangers 

as I sometimes came up short. It has meant begging for mercy as 

a repo man stands in my driveway at two o’clock in the morning 

to take my car. 

In conclusion, the VA’s mistakes and their delays involve more 

than just me. It is not about just Bettye McNutt. There are many 

Bettye NcNutts out there. 

Congress passed a law mandating that VA expeditiously process 

appeals like mine. However, VA routinely ignores this law. Now is 

the time for Congress to put teeth into that law so other widows 

like myself can get accurate and prompt decisions on their VA 

claims. 

Mr. Chairman, no one should have to go through that for 8,600 

days. Thank you for listening to me. 


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PREPARED STATEMENT OF BETTYE MCNUTT 

Statement for the Record 

Bettye B. McNutt 

Surviving Spouse of Vietnam War Veteran Ronald A. McNutt 

Before the Subcommittee on Disability Assistance and Memorial 

Affairs 

Committee on Veterans’ Affairs 

U. S. House of Representatives 

Regarding 

‘‘Adjudicating VA’s Most Complex Disability Claims: 

Ensuring Quality, Accuracy and Consistency on Complicated 

Issues’’ 

December 4, 2013 

Introduction 

Thank you Chairman Jon Runyan and Ranking Member Dina 

Titus for holding today’s hearing about ‘‘Adjudicating VA’s Most 

Complex Disability Claims: Ensuring Quality, Accuracy and Consistency on Complicated Issues.’’ 

My name is Bettye B. McNutt, and I am the widow of Vietnam 

War Veteran Ronald A. McNutt. Accompanying me is my attorney 

handling my claim, Glenn R. Bergmann, a partner of Bergmann & 

Moore based in Bethesda, Maryland. 

I am honored to be here to testify before the Committee on Veterans’ Affairs. The Subcommittee on Disability and Memorial Affairs invited me here today to discuss what has become a complex 

and now 23-year old claim for Dependency and Indemnity Compensation (DIC). 

DIC is a benefit provided by the U.S. Department of Veterans Affairs (VA) for surviving family members when a Veteran dies of a 

service-connected medical condition. 

I am here for two reasons. First, I am here seeking justice for 

myself and my family. I ask VA to correctly and promptly apply the 

law and grant my claim. I have waited eight thousand six hundred 

days too long. Without immediate intervention, my claim is destined to remain open for several more years as I wait, hoping and 

praying for VA to properly decide my claim. Because of VA’s frequent mistakes, I have been forced to live in poverty sometimes 

without heat and electricity as a widow raising a son orphaned by 

the Vietnam War. 

Second, I am here seeking justice for the other widows and orphans of our Vietnam War veterans, as I am well aware that there 

are many like me. In the audience today is my son, Brandon, and 

my niece, Sandra Peterson. She is the daughter of a Vietnam War 

veteran who also died from Agent Orange poisoning. Widows and 

their families should not be subjected to decades of delay. Sadly 

when faced with a denial most people give up. I think VA knows 

this. VA must quickly grant the worthy claims of other widows and 

orphans. VA must follow the law. 

The unnecessary waiting must end now, for me and for the many 

hundreds of other widows and orphans coping with the loss of a 

loved one due to cancers associated with exposure to Agent Orange 

during the Vietnam War. 

Ronald A. McNutt, 1947 - 1987 


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My late husband Ronnie was born in Memphis, Tennessee on December 31, 1947. As a 19-year old college student, he was drafted 

into the U.S. Army as an infantryman. Ronnie served honorably 

between November 16, 1967, and June 19, 1969. Ronnie deployed 

to the Vietnam War from April 30, 1968, to June 16, 1969. On September 22, 1987, at the early age of 39, he died from an aggressive 

form of cancer, leaving me a widow with a young son. His death 

came quickly from a cancer that invaded many parts of his body. 

Ronnie died within five months of his first diagnosis of cancer. 

I brought two pictures of my Ronnie with me today because this 

hearing is about my husband. He died because of the Vietnam War 

and his service to our country. On his death bed, just weeks before 

he died, he told me about how he swam in waters highly contaminated with Agent Orange. He told stories about using discarded 

Agent Orange barrels as makeshift barbeques. There is no doubt 

in my mind and in my doctor’s professional opinion that the dioxin 

poison in Agent Orange killed my Ronnie. 

I am here because our nation makes a solemn commitment to the 

families of our Veterans. At the west end of the Washington Mall, 

inside the Lincoln Memorial, are these important words: 

With malice toward none, with charity for all, with firmness in 

the right as God gives us to see the right, let us strive on to finish 

the work we are in, to bind up the nation’s wounds, to care for him 

who shall have borne the battle and for his widow and his orphan, 

to do all which may achieve and cherish a just and lasting peace 

among ourselves and with all nations. 

One phrase from President Abraham Lincoln is memorialized on 

a plaque on the front of the VA central office one block from the 

White House here in Washington, DC: 

... to care for him who shall have borne the battle and for his 

widow and his orphan. 

Request to VA 

I am here today seeking justice in my husband’s name, as VA appears to have forgotten the second part of the phrase, ‘‘for his 

widow and his orphan.’’ VA is not doing the job the American people expect and our Veterans’ families deserve. 

This claim has become complex despite the fact that I have satisfied all the legal requirements for DIC benefits. First, VA has not 

contested that my husband deployed to the Vietnam War, as shown 

by his discharge papers. Second, the law presumes Veterans deployed to the Vietnam War were exposed to Agent Orange. And, 

third, a medical expert provided VA with a ‘‘nexus’’ medical opinion 

concluding Ronnie’s cancer was ‘‘as likely as not’’ due to exposure 

to Agent Orange during his deployment to Vietnam. 

Complex Claim 

I originally filed my claim with the Jackson, Mississippi VA Regional Office on May 19, 1990. My DIC claim is difficult because 

it deals with Agent Orange on a direct basis. At one point, VA deferred (although probably lost) my claim for nearly 12 years, from 

1994 to 2006, apparently waiting on new research about the harmful effects of Agent Orange. I believe VA lost or simply forgot to 

process my claim until I reminded the agency about it in 2006. 

However, VA needlessly made my claim far more complex. VA 

gave contradictory reasons for denial; applied the wrong legal 


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standard; ignored evidence favorable to my claim; and sought evidence to deny my claim. 

In summary, during my 23 year battle to obtain VA benefits, VA 

improperly denied my claim seven times. Despite the fact that my 

DIC claim was returned by the Court of Appeals for Veterans 

Claims (Court) three times based on VA errors, VA still refuses to 

follow the law and science and grant my claim. 

My letters to the President and Congress are simply referred 

back to VA without action by VA. I feel that VA is waiting for me 

to die. 

VA Errors 

My 23 years fighting for justice is complicated and lengthy. I provided the Subcommittee with a detailed chronology which appears 

at the end of my statement. 

In summary, VA has made six significant mistakes on my claim. 

As a result, my claim now sits once again at the Board of Veterans’ 

Appeals (Board) awaiting adjudication yet again here in Washington, DC. Here are the most salient facts regarding VA’s chronic 

errors. 

1.VA’s first error: VA did not issue a Statement of the Case. On 

May 19, 1990, I filed my claim at the Jackson, Mississippi regional 

office. On December 10, 1990, VA improperly denied my claim. On 

February 7, 1991, I filed a timely Notice of Disagreement (NOD) 

to begin the appeal process. On November 16, 1994, VA issued a 

second rating decision. However, VA never issued a Statement of 

the Case in response to my original NOD, thus leaving my claim 

open and unadjudicated. 

2.VA’s second error: In response to a letter I wrote to VA on February 17, 2006, VA incorrectly considered my letter as a request to 

reopen my claim, even though my claim remained open and 

unadjudicated since 1990. Despite this, on June 3, 2006, VA denied 

my claim on the grounds I did not provide new and material evidence. 

3.VA’s third error: On June 3, 2006, VA approved a death pension, even though I didn’t apply for it. I returned the check they 

sent me because it was incorrect. 

4.VA’s fourth error: On August 4, 2009, the Board incorrectly denied my claim because it found that Ronnie’s cancer was not on the 

list of presumptive diseases associated with Agent Orange exposure. 

5.VA’s fifth error: On March 4, 2011, despite the existence of a 

favorable medical opinion by Dr. Carey that found a causal link between my husband’s death and exposure to Agent Orange in Vietnam, the Board again denied the claim because my husband’s cancer was not the type of cancer on the list of presumptive diseases 

associated with Agent Orange exposure. 

6.VA’s sixth error: In a March 2012 letter to the Chief of Staff 

at the VA Medical Center in West Virginia, the Board declared the 

private medical opinion which it had previously stated it had ‘‘no 

reason to doubt’’ was contradictory and ordered its own independent medical expert opinion. Relying on an outdated Institute 

of Medicine (IOM) study, the ensuing VA opinion found that there 

was a less than 50% probability that my husband’s cancer was the 

result of in-service herbicide exposure. 


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7. VA’s seventh error: In September 2012, the Board denied my 

claim again finding the VA medical opinion more probative than 

the private medical opinion, despite a follow-up medical opinion refuting the VA examiner’s findings and a written brief submission 

by my attorneys on August 6, 2012. 

I am upset at VA’s behavior because VA appears to be opposing 

me at every turn. VA can easily grant my claim right now if they 

reviewed the evidence of record and correctly applied the law. This 

is not a difficult claim, but VA has made it complex. VA denied my 

claim for 23 unbearable years based on conflicting reasons. If VA 

follows the law and stops their seeming effort to undermine my 

claim, it will be granted as I have satisfied all the requirements 

DIC. 

Hardship 

As noted above, I commenced this claim some 23 years ago. VA 

has provided inconsistent reasons for denying my claim which continues to cause me enormous frustration and hardship. 

The impact on my son Brandon was tremendous. He lost his father at the age of 12. Ronnie’s death upended Brandon’s young life. 

He started failing in school, suffered from nightmares, and severe 

nervousness which resulted in ridicule by teachers and students because of the change in his behavior. His dad did not see him graduate from high school, attend his prom, or be there to mentor him 

as a good father. 

For me, I’ve suffered unimaginable emotional grief from Ronnie’s 

death. I’ve done the best I can as a widow to provide for my son. 

Despite the fact that I worked, my son and I experienced severe 

economic hardship. We simply learned to do without for a very long 

time. There were times when we did not have enough food. We 

learned to rely on friends and even strangers to provide simple groceries. I would sometimes come home in the dark to a house that 

had no heat or electricity because I could not afford to pay the bills. 

It sickens my heart that VA simply does not follow the law or 

science. My claim should have been granted decades ago. 

8,600 Days 

In conclusion, I seek justice for my husband Ronald who died 

from cancer due to Agent Orange poisoning. I ask VA to grant my 

DIC claim. I have waited eight thousand six hundred days too long. 

For the other widows and orphans of Vietnam War veterans who 

died due to Agent Orange, I ask VA to improve training so that VA 

employees follow the law, consider favorable evidence, and stop trying to find reasons to deny claims. 

This is not just about me. In 2003, Congress passed a law mandating that VA expeditiously process appeals like mine. However, 

VA routinely ignores this law. Today, VA’s ‘‘expeditious’’ treatment 

equates to at least four more years of additional delay. 

I wish Congress would put teeth into that law so the thousands 

of other widows and Veterans get accurate and prompt decisions on 

their VA appeals. 

Thank you again for this opportunity to appear here today. I will 

gladly answer your questions. 

Mr. RUNYAN. Thank you for your testimony. 

And both, Ms. McNutt and Ms. Price, thank you for being here 

and putting your personal view to all of us. 


VACREP180 with DISTILLER
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We will start with a round of questions. I know the clocks are 

not up, but we will be able to see it from this end. So to get moving 

in a timely manner, the first question is for Ms. McNutt. 

Talking about this process and moving it forward with—you are 

accompanied by your attorney, Mr. Bergmann, here. Could you tell 

us about when you decided to engage in counsel and how that has 

helped you to get to where we are today in this process because 

like you just kind of alluded to, there are many, many other people 

out there in the same situation? 

Ms. MCNUTT. Well, as I said, I was introduced to Agent Orange 

on his death bed. And after his death, that was forever in the front 

of my mind. 

So I proceeded without any help, without any direction. I started 

researching the chemicals in Vietnam. I read an article in a newspaper and it was talking about Agent Orange. And I filed a claim 

in 1990. 

Most of these were just, as I said, stumbling in the dark grasping. But as I went along, the more I learned and the more I felt 

it was something that I had to do because my husband told me 

about this on his death bed for a reason which at the time I did 

not understand. 

Mr. RUNYAN. Can you give a little insight, though, on how counsel—— 

Ms. MCNUTT. After 20 years of groping in the darkness and dealing with the VA and all their errors, I prayed. I asked for help. And 

one day I received a call from the Vietnam Veterans of America 

and I was told that I might want to seek counsel. 

I went online and I found Mr. Bergmann. And I decided this is 

going to be the person that is going to help me. This is who I want 

to represent me. 

Mr. RUNYAN. Mr. Bergmann, can you elaborate a little on what 

you have done to expedite the process, if you will? 

Mr. BERGMANN. Certainly. Thank you. 

As Mrs. McNutt has indicated, she commenced her claim in 1990 

and her claim sat for over 12 years. When we came on her case— 

as former VA counsel, my job once I left VA’s employ—our job as 

attorneys is always to connect the dots, to make sure that the evidence that is needed to satisfy the requirements is presented to 

VA. 

VA is supposed to in a non-adversarial posture, paternalistic posture, to give notice to veterans and widows and they routinely do 

not do that. 

So what we did in Ms. McNutt’s case is we assisted in getting 

the medical evidence which was not difficult. Her husband had a 

very aggressive form of cancer at the age of 39. And we put the 

evidence together with our arguments and submitted it to VA. And, 

you know, we can do all we can to dot our Is, cross our Ts, but we 

cannot make VA properly apply the law. 

And we have been up to the U.S. Court of Appeals for Veterans 

Claims three times and each time, a VA attorney will trot forward 

and say, you know, we made a mistake, this case needs to go back. 

That does not help Mrs. McNutt, but we are hopeful that—despite 

23 years—we are hopeful we are near the end. 


VACREP180 with DISTILLER
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Some of the help that we get along the way, obviously the Veterans Choice Act of 2006 has been helpful in allowing attorneys 

early access to assisting veterans and widows. 

Mr. RUNYAN. Thank you. 

And one question for Ms. Price. From all the testimonials you 

have taken from veterans on a national scale, what are the most 

frequent errors you have heard of in the process? 

Ms. PRICE. Not necessarily in any ranking order, Chairman, but 

most specifically as counsel, Mr. Bergmann, said failure to apply 

the law correctly, complete disregard of medical evidence provided, 

most specifically from civilian providers. That is very high on the 

list. 

And the third one, and this rides to the top pretty regularly, is 

the almost complete and utter disregard for anything that is considered a policy, rule, regulation, or law. The raters seem completely incapable of rudimentary reading of their own policy. 

I have a very specific one in my case. The secretary sent down 

a policy change, an order directly to the regional offices with regard 

to those of us exposed to burn pits in Iraq and Afghanistan April 

26th of 2010. 

That application of that policy change has, to the best of my 

knowledge, not been addressed once in the almost 5,000 victims I 

know personally. 

Mr. RUNYAN. Thank you. 

And with that, I yield to the ranking member for her questions. 

Ms. TITUS. Thank you. 

And thank you both for your testimony. You are very courageous 

to come and we appreciate your willingness to share your stories. 

We do not want to see anybody else have to go through what you 

have. 

I understand the general dissatisfaction and the desire to make 

the VA follow the law and to overhaul the way they do business, 

but can you tell us just one, just start with one specific thing, and 

I would ask both Ms. McNutt and Ms. Price, one thing that could 

do through legislation that would make the process work better because that is what we have to work with. 

How can we change the law or how can we change the policy in 

a specific way that would improve circumstances? 

Ms. Price. 

Ms. PRICE. Yes, ma’am. I have a very specific answer for you. 

Ms. TITUS. Okay. 

Ms. PRICE. You could create a law that essentially orders the secretary to establish a complete set of repercussions and an oversight 

agency that has the ability and the authority to dish out those repercussions, that when malfeasance, deliberate especially, is shown 

on the part of a rating official, on the part of a case manager, on 

the part of a healthcare provider, that those people can be terminated, that those people can suffer the repercussions like any civilian would for doing their job poorly or deliberately not doing their 

job the way it is supposed to be done. 

Ms. TITUS. And I would ask the attorney if somebody is guilty 

of malfeasance in doing their job, aren’t there already in place 

some ways to go after that person? You were a VA attorney; is that 

correct? 


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Mr. BERGMANN. Are you talking about the VA? 

Ms. TITUS. I am talking about in response to what Ms. Price just 

said. 

Mr. BERGMANN. I do not deal much with malfeasance issues. 

What I deal with, Ranking Member Titus, is appeals where each 

case that comes down from the court has language citing to the 

law, Title 38, Section 7112 that says this case will be given expeditious treatment. 

Now, and I realize I am not being responsive to your question—— 

Ms. TITUS. I can ask the VA for some of that information. I appreciate that suggestion. 

Ms. McNutt. 

Ms. MCNUTT. There has got to be someone somewhere that has 

the total authority in making sure that the training—they say 

there is lack of training, lack of technology. I do not understand 

that. If I acted in those ways, I would have been fired. 

But I think stronger force should be put on them to enforce the 

law by putting someone in place or maybe more than one person 

that would oversee that this law is enforced, that it is a serious 

matter and that something has got to change. 

And I am with her. If you cannot perform the job, find another 

job. 

Ms. TITUS. Thank you, Mr. Chairman. 

Mr. RUNYAN. I thank the gentle lady. 

With that, I recognize Mr. Lamborn. 

Mr. LAMBORN. Thank you, Mr. Chairman, and thank you for having this hearing. 

And thank you all for being here. 

And I want to build on what the ranking member just asked. Mr. 

Bergmann, you have been on both sides now legally with your employment previously and what you do now. 

Do you have any advice or guidance you would give this committee on how the VA could work its claims process better? 

Mr. BERGMANN. I guess the advice I would give, sir, is that there 

be accountability. What I see is a lack of accountability at the 

agency level where we are not supposed to be on opposite sides of 

the aisle. 

VA will not talk to us. If we do get someone on the telephone, 

they will ask us how we got their number. We get differing responses each time. We cannot handle many cases at the agency 

level sometimes because we do not know where our file is because 

we get different responses to that. 

So I think if we can hold the folks who are deciding these claims 

accountable, that would help veterans and widows and their counsel in expediting the process. 

Mr. LAMBORN. Accountability, that is a great thing to bring to 

our attention. Training and incentives, do you have any advice in 

those areas? 

Mr. BERGMANN. As Mrs. Price talked about, she indicated her 

concern that it seemed like that some VA ratros decision makers 

but only 20 percent do not follow simple guidelines. Absolutely 

training is key. 


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I think the VA’s OIG report of last year indicated that, and I 

may be misquoting and I think the OIG is going to provide a report 

later today, but only 20 percent of their ratros decision makers are 

properly trained. That means 80 percent are under-trained. These 

are people who are deciding our veterans’ disability claims. This is 

not acceptable. 

Mr. LAMBORN. Okay. Thank you. 

Mrs. Price, I want to thank you for your service. 

And, Ms. McNutt, I want to thank you for your husband’s service. 

Mr. Chairman, I yield back. 

Mr. RUNYAN. I thank the gentleman. 

With that, I recognize Mr. O’Rourke. 

Mr. *O’Rourke.* Thank you, Mr. Chair. And I would also like to 

thank the chairman for organizing today’s hearing in the manner 

in which he has organized it. 

Very often we will hear from representatives from the VA and 

then afterwards perhaps hear from VSOs or others who are impacted. I like this order because I am really looking forward to 

hearing the VA’s response to the issues that you brought up. 

And the word that we keep hearing over and over again is accountability. And to use your word, Ms. Price, repercussions. We 

want to see how that accountability is implemented and what the 

consequences are when someone does not do their job properly or 

when there is the case of malfeasance or someone who is working 

against the interest of the veterans that they are supposed to 

serve, we want to know what the consequences are specifically. 

And I think you raised a great point. One hit home with me and 

it sounds like with the rest of the committee. 

And, Ms. McNutt, as I said earlier when I had a chance to meet 

you before the hearing began, I commend you on your courage in 

being here. I hope that your story helps galvanize the VA, you 

know, one, to resolve your claim which has taken far too long already, but also to serve as the added inducement to ensure that no 

one else is suffering what you have been through and to bring stories like yours to our attention as an oversight committee and body 

and to the attention of the VA. 

So really appreciate your service, Ms. Price, and through you, 

Ms. McNutt, your husband’s service and your support of him and 

his legacy and memory and both of you, your reference on behalf 

of other veterans and veterans’ families who are suffering these 

same kinds of problems. 

So I really do not have any questions. I will reserve those questions for the VA based on the issues that you brought up. I just 

want to let you know that your stories have hit home and I really 

do think they are going to have their intended effect of changing 

the culture and adding additional power to our ability to exercise 

oversight over the VA. So thank you. 

Mr. Chair, I yield back. 

Mr. RUNYAN. I thank the gentleman. 

And the chair now recognizes Mr. Bilirakis. 

Mr. BILIRAKIS. Thank you, Mr. Chairman, and I appreciate you 

holding this hearing, a very important hearing. 


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And I appreciate the testimony. Mrs. Price, who I know pretty 

well, we worked together over the years on VA issues. And, Mrs. 

McNutt, thank you for your courage and I know you will make a 

difference for others. 

And I really appreciate so very much for both of you testifying 

today. 

Mrs. Price, first of all, thank you for your service as well. Thank 

you for testifying, and I want to ask you a couple questions if that 

is okay. 

You have met with me over the years on particular cases, and 

I really appreciate it, and you worked with my district office as 

well to help our true American heroes, our veterans. 

I have a question with regard to, again, give—can you explain, 

elaborate a little bit on your particular case, the experiences that 

you had over the years? I think that would be helpful to the committee as well, if you will. 

Ms. PRICE. Thank you, Congressman. 

It has actually been my honor and privilege to work with you 

over the last few years, in particular for other veterans’ issues. I 

know you are extremely supportive of all of us that have come 

home whether we need VA services or not. 

But to answer your question, when I got home, I was still on active duty. I was stationed at SATCOM and I was sick and I was 

injured. And I went through the medical board process and it 

took—by the time we completely finished, it took about 10, 11 

months for me to get through my board process. 

But I stayed on active duty for 18 months total. And my first rating from the VA came in and it said you have 30 percent. There 

is a rule in place called the DeLuca criteria that has been around 

for decades based on a court case. It has to do with every single 

one of us that has bilateral appendage injuries, arms, legs, ears, 

eyes, anything you got two of. 

Up until the time I had a DRO hearing, I had it appeared to be 

the same case manager. Because I am an English aficionado and 

the method in which the way the person wrote letters to me, the 

verbiage the person used seemed to be the exact same person every 

time. 

The raw rating on my hands is 230 percent and that is a big 

number, but they have a very algebraic method of using cumulative 

math. Both of my hands, I had the bones removed and my tendons 

rerouted so that I could actually even hold this. I cannot tie my 

shoes. I cannot button buttons. I cannot do zip lock bags, all kinds 

of things. 

My last surgery was while I was still on active duty. I also contracted this lung disease. 

When I sent all of this information in including some very elaborate ratings on my hands, the testing that took five hours, the first 

letter that came back to me was telling me that the amputation 

rule did not apply to me which is a very basic rule that the VA has. 

When you hit a certain calculation level, we just said, okay, we 

are done. You know, we are too high up. Now you just go over and 

use the amputation rule and you treat it as loss of use or loss of 

the limb. Said you did not lose your hands, what makes you think 

you get to use the amputation rule. 


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I had essentially that same answer all three appeals. My lungs 

they told me I did not, both my lungs and my hands, they told me 

I did not qualify for combat-related or SMC. 

I was a convoy driver. I have over 350 missions. I drove 

Humvees. I drove LNTVs. I even drove an Iraqi city bus in downtown Baghdad. And I provided all of that information in my case, 

pictures taken by combat cameras of me driving. They still denied 

me over and over and over again. 

I have PTSD for a variety of reasons up to and including being 

a combat driver. When I filed the claim, they denied me right 

away, immediately. They said you do not have it. Our evaluator 

said that you must have had a bad childhood. No, actually, I did 

not. My childhood was not terrible. It was not great. I was a kid. 

But it had to do with the issues that happened over there. 

And I was being treated by their own psychiatrist and their own 

psychologist for a year who said I had PTSD, but yet they still denied me. Does that answer your questions, Congressman? 

Mr. BILIRAKIS. Yes, yes. 

Ms. PRICE. Thank you very much. 

Mr. BILIRAKIS. Thank you very much. 

And I know my time has expired. Will we have another round? 

I know you have three. Can I have one more question? Thank you 

very much. 

Ms. Price, the VA stated in its testimony that from 2009 to 2013, 

the average number of issues included in a disability claim increased from 2.8 to 4.9 and that the VA is issuing lanes as an organizational structure to process complex claims. They stated that 

the core lane includes claims with three or more medical issues 

that do not involve special populations of veterans. That is a quote 

there. 

Can you expand upon your thoughts about this aspect of the VA’s 

testimony? 

Ms. PRICE. Specific to core claims? 

Mr. BILIRAKIS. Specific to the process. 

Ms. PRICE. Okay. 

Mr. BILIRAKIS. Yes. 

Ms. PRICE. Putting things into lanes? 

Mr. BILIRAKIS. To lanes, correct. 

Ms. PRICE. Okay. 

Mr. BILIRAKIS. Correct. 

Ms. PRICE. Does anybody here drive in traffic? Does anyone here 

ever drive on the Beltway? You have lanes. There are only so many 

and there are express lanes. And in theory, everybody uses the express lanes. How many people have seen the news stories about the 

guy riding with the mannequin in a seat to get into the express 

lane? 

Yeah, there are going to be ones that go into those express lanes, 

but our special operations claims, I love that they took that title, 

we have complicated claims. Those complicated claims are still 

being ignored and still being pushed aside because the lane that 

they have has a group, a group of adjustors and raters that are 

dealing with them. 

Instead of them being either brokered out to other regional offices that do not have a backlog like Nebraska, Oklahoma, they are 


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not brokering them out, they set on them. And then they have 

these core which I do not even get what core is. Okay. So you have 

three. They have they call them the express lane for one or two. 

If you hit three, but it does not hit into what seems to be a rather 

fluid definition of special or complex, you end up in the core. 

They are also not giving any information as to what the qualifications are of these people that are managing those lanes or those 

raters that are working in those lanes because experienced rater 

does not tell me anything. How many years did they have rating 

medical claims for MetLife before they went to the VA? 

Mr. BILIRAKIS. Thank you. 

I will go ahead and yield back. Thank you, Mr. Chairman. 

Mr. RUNYAN. The chair recognizes Ms. Negrete-McLeod. 

Ms. NEGRETE-MCLEOD. No questions. 

Mr. RUNYAN. No questions. 

Chairman Miller? Nothing. 

I want to thank you all again for your testimony and being here 

today. You are now excused and we will ask the second panel to 

come forward to the witness table. 

At this time, I welcome panel two which includes Mr. Sherman 

Gillums, the associate executive director for Veterans Benefits, 

Paralyzed Veterans of America; Mr. Ronald Abrams, joint executive 

director of the National Veterans Legal Services Program; and Mr. 

Zach Hearn, deputy director of Claims with The American Legion. 

We appreciate all your attendance today. Your complete and 

written statement will be entered into the hearing record. 

Mr. Gillums, you are now recognized for five minutes for your 

testimony. 

ORAL STATEMENT OF SHERMAN GILLUMS 

Mr. GILLUMS. Thank you, Mr. Chairman. 

Chairman Runyan, Ranking Member Titus, Members of the subcommittee, on behalf of Paralyzed Veterans of America, I want to 

thank you for this opportunity to discuss complex claims, a topic 

that is near and dear to veterans like me and those we represent 

at PVA. 

Complex claims by their nature involve those cases that require 

the most experienced eyes and minds to properly adjudicate. These 

can be the oldest claims in the inventory, claims with multiple 

issues or those presenting the most complicated circumstances to 

unravel such as military sexual trauma, PTS, and catastrophic disability. 

Since membership in PVA is predicated on catastrophic disability, that will be my focus. 

PVA service officers have honed a unique expertise in developing 

and advancing the most complex claims in the system. Where special multi compensation or SMC claims are often the exception for 

most accredited representatives, they are fairly common for PVA. 

So we appreciate this long overdue focus on complex claims. 

The Veterans Benefits Administration has made tremendous 

strides in reducing the backlog since launching the 21st century 

transformation initiatives. But as we said during our June 2012 

testimony complex claims remain problematic because disability 

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culators too often oversimplify cases that require critical thinking 

and inductive reasoning, not algorithms, to adjudicate with true accuracy. 

So any accuracy numbers achieved through the use of these processes are qualified by context as it relates to complex claims. The 

problem is defining accuracy of these cases often lies in the eye of 

the beholder. If by accuracy VA means the veteran receives maximum entitlement, then accuracy targets remain unmet. 

VA contextualizes accuracy to mean if the rator inputs a given 

data set such as the boxes checked on a DBQ or C&P exam results 

and follows the rules-based prompts, the decision will be free of 

error based on this algorithmic construction. 

The problem is disability evaluation builders do not encourage 

the application of judgment-based principles like reasonable doubt 

or guide rating specialists through ambiguities in the evidence by 

reconciling the difference between total loss of bladder control 

versus neurogenic bladder sphincter and someone with a spinal 

cord dysfunction. 

And this is where we have issues with the way complex claims 

are adjudicated under a rules-based system. 

A veteran with a severe disability may receive an accurate SMC 

rating under VA’s definition based on limited evidence and binary 

rules but not the most accurate rating possible that reflects the 

true extent of disability or need. 

And I will give you a case in point that deals with the terrible 

condition that PVA sees all too often, ALS or Lou Gehrig’s disease, 

a fatal motor neuron disease that does not slow down for the painstaking protocols that VA must follow. 

Since the passage of the presumptive rule on ALS open entitlement to veterans and survivors, PVA has worked over 6,200 ALS 

claims which has made our field staff more familiar with these 

complex cases and extremely staunch in our insistence that they 

are timely and accurately adjudicated. 

So you can imagine my reaction when I heard about a veteran 

in San Diego who received notice that he needed to submit to a 

compensation and pension exam to prove his need for skilled care 

despite presenting competent medical evidence of such need from 

his treating physician. 

The VA has the prerogative to call claimants in for exams pursuant to a claim, but this prerogative has become one of those intractable rules that we criticize. The problem is this veteran was in 

hospice so he could not submit to an exam. 

The VA rater, an experienced lane coach, was bound by the quality-driven rule that C&P exams are mandatory even though he had 

enough evidence to grant this R2 claim and the regulatory discretion to do so under Title 38 which states any hospital or exam report from a government or private entity may be accepted for rating a claim without further examination. 

VHA directive unacceptable clinical evidence also allows VA examiners to supplement the review of claims files with a telephone 

interview if necessary with the claimant in order to complete a 

DBQ. 

When neither option was exercised here, the words hospice and 

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quirement to order a C&P exam in the name of quantity. Instead 

of serving as prima facie evidence of imminent death, thus substantiating the need for regular skilled care, common sense will give 

way to a calculator which is supposed to be a decision support tool, 

not replacement for one’s reasonable faculties. 

To make this point, I offered an analogy. Three plus two always 

equals five. And if every disability claim were based on metrics like 

decibel level or percentage of range of motion, a high degree of accuracy will be achievable under the current system. 

But these complex claims are like adding two irrational numbers, 

pi 3.14, so on and so forth, plus the square root of two, to arrive 

at an outcome that cannot be precisely summed with a calculator. 

In that same vein, these claims call for informed, qualitative analysis to find the most accurate albeit imprecise answer. 

That answer was never found in the San Diego case as the claim 

ultimately died when the veteran finally succumbed to his ALS. 

This was a missed opportunity to do the right thing. Unfortunately, 

this was not an isolated case. We see VA regional office staff across 

the country pointing to the same rules to justify taking unnecessary steps in similar cases. 

And I can point to one in Nashville for Ms. MacDonald who is 

going to follow this panel. She is the regional office director who 

will testify. 

And, of course, in New Jersey, Mr. Chairman, I also have a case 

for you if you are interested. 

We understand the dilemma VA faces under pressure to reduce 

the backlog while achieving timeliness and accuracy targets, but 

every aspect of this problem is not a numbers game. 

In the case of complex claims as we define them, there are no 

shortcuts to doing them right. They require experienced minds that 

are free to apply common sense and pro veteran legal principles 

like reasonable doubt or foregoing C&P exams when existing evidence is satisfactory in the qualitative deliberation of claims with 

no black and white answers. 

As I said earlier, accuracy is not about how well VA raters adhere to a set of protocols to arrive at an ostensibly logical outcome 

notwithstanding obvious blind spots in the process. 

Accuracy is measured by whether VA has provided the maximum 

benefit possible in these complex claims with imprecise answers 

that do not lend themselves well to binary propositions and calculators. 

Thank you, Mr. Chairman, Ranking Member Titus, and Members 

of the committee, and I will be happy to answer any questions you 

have. 


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PREPARED STATEMENT OF SHERMAN GILLUMS 

Chairman Runyan, Ranking Member Titus, and members of the 

Subcommittee, Paralyzed Veterans of America (PVA) would like to 

thank you for the opportunity to offer our views on the adjudication 

of VA’s most complex disability claims to ensure quality, accuracy 

and consistency on these complicated issues. PVA has a unique expertise in dealing with complex claims because PVA members have 

complex disabilities as a result of spinal cord injury or dysfunction. 

The Department of Veterans Affairs (VA) has fully deployed its 

new processing model for disability compensation claims, called the 

Veterans Benefits Management System (VBMS), in order to reduce 

the number of backlogged claims. This paperless processing model 

places an emphasis on expediting claims where the supporting documentation is fully developed by the Veteran. But the success of 

VBMS greatly depends on the process design, like rules-based processes, and supportive technologies like Special Monthly Compensation (SMC) calculators, that undergird the system. Unfortunately, 

rules-based systems treat all veterans the same and can be flawed 

by imperfect rulemaking and application. This is the challenge for 

a rules-based computer system; it does not have the human interaction to fully understand the circumstances of a specific injury. 

The numerous issues faced by veterans with catastrophic injuries 

create a complex set of outcomes that cannot be easily reconciled 

by logic-based systems that cannot appreciate nuance in disability 

assessments. Calculators used in rules-based systems historically 

fail to compute the right ratings for persons with multiple issues. 

This type of decision analysis uses decision trees that attempt to 

enable the rater to simplify and resolve complex questions. This 

technique, however, can be problematic when the analysis involves 

highly qualitative assessments that are reduced to binary choices. 

This processing model also handles claims for veterans who have 

unique circumstances, such as financial hardship, homelessness, or 

serious injuries or disabilities in special ‘‘segmented lanes.’’ The 

problem is the growth in the number of claims considered ‘‘complex’’ since September 11, 2001. Complex claims, according to VA, 

are characterized by the number of issues per claimant filed, which 

has doubled to 8.5, when compared with claims from past wartime 

eras. Also of significance, of the 47,814 complex claims currently in 

the VA inventory, over half are backlogged. In fairness, this number has steadily decreased over time. But they still take too long 

to adjudicate in many cases, particularly for our members with terminal ALS. 

PVA has developed the unique expertise in dealing with complex 

claims because PVA membership is predicated on having one of the 

most complex disabilities one can have: spinal cord dysfunction, 

whether due to injury or disease. This can occur due to trauma, 

ALS, MS, and other debilitating causes, and often manifests in 

both primary and secondary residual losses throughout the bodily 

systems, including the often under regarded ‘‘invisible’’ aspects of 

injury like mental impairment, need for attendant care, and helplessness. Complex claims in this regard go beyond the mere number of issues. 


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Accurately rating these losses for claim purposes requires expertise in neurology, physiatrist, urology, psychiatry, and other specialty areas. But during Compensation & Pension (C&P) examinations, it is common to see a general practitioner authoring medical 

opinions on etiology, nature and extent of dysfunction and cumulative effect of separate yet concurrent disabilities. This is not a 

problem when the examiner devotes enough time to understanding 

the disability and its nuances before rendering a conclusion. However, this is not always the case. As a result, when these opinions 

result in lower ratings than the veteran should have, the ensuing 

debate takes on a subjective hue when the regulations alone do not 

persuade a decision reversal. 

While VBA has instituted an evaluation system that assigns 

greater weight to complex claims, these claims are often too esoteric for journeyman raters, full of embedded issues and ambiguities both legal and medical that lead to errors. Moreover, these 

issues do not lend themselves exclusively to rules-based analysis 

without inductive, common sense reasoning in many cases, such as 

reasonable doubt provisions, which seems to have slowly disappeared from training and guidance for new raters. However 

working these cases requires a combination of experience and openmindedness to do so correctly. 

For example, in one PVA case a veteran with ALS submitted evidence supporting a higher rating for Special Monthly Compensation at the R–2 rate from his treating physician, thus verifying his 

need for skilled care in his home. Despite substantiating his need 

with credible medical documentation, he had to subsequently submit to a C&P exam at the VA’s direction where the examiner concluded he did not need skilled care on a daily basis because he had 

little movement. Not only did the examiner improperly contemplate 

movement as a basis for determining need for care, VA misapplied 

its own regulation on resolving doubt when two expert opinions 

conflict. When common sense is applied, there is little doubt on the 

question of whether a veteran with terminal ALS, an incurable, 

quickly debilitating condition with foreseeable, inevitable consequences, needs skilled care. This case out of the San Diego VA 

Regional Office illustrates what happens when a profoundly complicated set of disabilities, a lack of expertise, subjective interpretation of regulations, and rules that do not allow for a ‘‘common sense 

override’’ option collide in a veteran’s claim. In this instance, the 

veteran presented enough evidence from his VA clinician, yet VA 

still required a VA examination per inflexible VA guidance in such 

cases (see M21–1MR Part IV, Subpart ii, Chapter 2, section H). 

While PVA commends the Veterans Benefits Administration (VBA) 

for implementing such initiatives as the Acceptable Clinical Evidence option, which allows a rater to decide based on the record in 

lieu of a C&P exam, this has not taken root system-wide and needs 

to be. 

It would also help to eliminate redundancies such as unnecessary 

C&P exams that either corroborate the evidence of record or create 

arbitrary bases for denying a claim. PVA has long criticized VA’s 

overuse of C&P examinations particularly when the evidence of 

record already substantiates the claim. These exams attempt to 

provide a snapshot of complex disabilities based on cursory review 


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of the medical history and templates, called Disability Benefits 

Questionnaires (DBQs), that ask a lot of questions but not always 

the right ones. For example, ‘‘Need for higher level of assistance’’ 

is not asked on the ALS DBQ, even though the terminal nature of 

disease makes constant need for specialized care likely in virtually 

every case. And with the addition of rules-based calculators that 

make C&P exams a mandatory step in many instances, these incorrect decisions are given the patina of unassailable faultlessness. 

PVA is on record stating that rules-based calculators and processing are not conducive to accurate analysis where complex 

claims, as we describe them, are concerned. They can be adequate 

starting points. But these claims require experienced raters who, 

for example, would not conclude that a veteran who can barely 

stand up due to lost ‘‘useful’’ function should be rated the same as 

a veteran who can walk but with difficulty. Or that a veteran with 

paraplegia cannot be considered in need of aid and attendance because he manages his neurogenic bowel and bladder and dresses 

independently thus no longer functionally disabled. 

Experienced raters, not algorithms, best factor in the nuances of 

special monthly compensation and areas of subjective interpretation that can lead to an incorrect decision. For this reason, as we 

asserted in June 2012 hearing testimony, reducing the backlog 

through the use of technologies cannot come at the expense of accurately rating the most complicated claims in the inventory. This is 

why PVA trained its service officers to fully develop a claim long 

before VA idealized the Fully Developed Claim concept. Our service 

officers know what questions to pose to an examiner, how to reconcile the medical and legal ambiguities, and how to draw a path 

toward entitlement for the rater from the time the claim is filed. 

But not every rater, particularly the new ones, can or feel empowered to see past the inflexible rules and seemingly indisputable 

C&P examinations enough to question or deviate when necessary. 

Perhaps that is how it has to be in the grand scheme of the entire backlog and we understand that rules are critical to organizational success. But the exceptions are the rule for PVA. A veteran 

with terminal ALS died in hospice while his claim was pending before a ‘‘Special Ops’’ lane coach because he needed a DBQ despite 

the fact that the evidence of record supported entitlement. A utilitarian system that successfully delivers benefits to one million veterans, but overlooks the most vulnerable, is inconsistent with 

moral obligation derived from Lincoln’s promise to those who 

served our country. As VA celebrates the success in reducing the 

backlog through the use of new technologies and innovative processes, more attention now needs to shift toward developing strategies for adjudicating complex claims more timely and accurately. 

PVA believes there are several things that can be done to improve support to veterans needing SMC: 

* SMC cases should be assigned only to the most experienced 

raters and VA must ensure that new raters are properly trained 

on SMC and its applicable regulatory doctrines. 

* VA needs to allow for the application of a ‘‘common sense’’ override when rules-based processes limit or preclude necessary subjective analysis such as reasonable doubt or the weight/credibility of 


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evidence, or fail to reconcile ambiguities in the medical evidence or 

legal applications 

* It is critical that if denial of a complex claim is predicated on 

a C&P exam, particularly in cases of terminal illness or catastrophic disability, the reasons and bases must detail how the 

weight of all evidence was assigned, whether reasonable doubt applied or not, and whether the acceptable clinical evidence option 

was considered in lieu of ordering a C&P exam. 

* VA must expand acceptable clinical evidence (VHA Directive 

2012–025) for nationwide implementation. 

* And finally, VA must ensure the rules-based process allows for 

and encourages the application of 38 CFR §3.102, which defines 

‘‘Reasonable doubt’’ doctrine. Accordingly, ‘‘When, after careful consideration of all procurable and assembled data, a reasonable doubt 

arises regarding service origin, the degree of disability, or any 

other point, such doubt will be resolved in favor of the claimant. 

Reasonable doubt means one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.’’ (Authority: 38 U.S.C. 

501(a)) 

Historically, due to the nature of our catastrophically disabled 

membership, PVA has been the subject matter expert for claims involving multiple injuries or conditions. PVA has enjoyed the privilege of providing VA with help in field studies and advice on processes that best meet the unique needs of veterans with catastrophic 

injuries. PVA National Service Officers have even participated in 

the training of VA claims processors. This valuable service has tremendously benefited both organizations and illustrates an important, enduring partnership. PVA’s success in claims processing has 

been due to diligence in training our service officers and in understanding the challenges faced by those with the most complex of 

cases. VA must do the same. Data processing is no substitute for 

education, training and understanding. We fear that as VA continues to aggressively look to reduce the backlog, complex claims 

may move further behind. While advances have been made in processing theses claims for those most needing, we caution the Subcommittee and VA not to become too satisfied with their own success to not see those still left behind. PVA looks forward to continuing to make VA aware of the need to keep complex claims in 

the forefront and to ensure they are properly and quickly adjudicated, particularly as they impact our most catastrophically injured veterans. 

This concludes my testimony. I will be happy to answer any 

questions you may have. 

Mr. RUNYAN. Thank you, Mr. Gillums. 

With that, I will recognize Mr. Abrams for five minutes. 

ORAL STATEMENT OF RONALD ABRAMS 

Mr. ABRAMS. Thank you. 

I have been involved in veterans’ law for over 40 years. The VA 

has faced huge backlogs before and the VA has had to deal with 

reducing the backlog, adjudicating claims faster, and in almost 

every instance, the error rate, especially the error rate for complex 


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claims, has gone up. You just simply cannot go too fast when you 

have complicated claims. 

The first thing we have to talk about is what is a complex claim. 

Some claims by their very nature are complicated, special monthly 

compensation, traumatic brain injury. In fact, the regulation dealing with TBI is so complicated that some people call it the Da Vinci 

code. Try and look at it sometime and you will be impressed. 

Some claims can be complex as they are developed by the VA or 

as evidence from the claimant comes in, ancillary issues arise, different theories of service connection come up. They can become 

very difficult. 

And some claims, more than a few and more than I like, can become complicated because of VA error. And in those cases veterans 

face a nightmare. Not only do they have to get the right evidence 

before the VA, they have to overcome the unfair denial which is an 

obstacle that stands in their path. 

The worst type of VA errors are the result of premature adjudications. Some VA ROs incorrectly adjudicate and prematurely deny 

claims based upon inadequate evidence, especially inadequate VA 

exams. These errors reveal for many veterans that the claims process can be adversarial. Based on my experience working for the VA 

for many years, working for NVLSP, going on quality checks to 

over 40 VA regional offices for the American Legion, who should be 

commended for doing that work, shows to me that the error rate 

at the VA has been consistently at least 30 percent in the various 

ROs. Sometimes it is higher. It is unrealistic to assume that the 

VA will ever get its real error rate to 98 percent. 

Over 70 percent of the claims appealed to the Board of Veterans 

Appeals are reversed, or remanded. And over 70 percent of the 

claims taken to the Court are sent back because of VA error. In 

fact, NVLSP wins over 90 percent of the claims that it takes to the 

Court. 

In its rush to judgment we have found that many ROs, VAROs, 

prematurely deny or ignore many claims and potential claims. Unfair premature denials cause unnecessary appeals and years of 

delay before deserving veterans obtain justly earned benefits. And 

even more important some veterans fall through the cracks. Adjudicating many claims quickly does not do much good if many of 

these adjudications are done in a premature manner and many deserving veterans are unfairly denied. What will happen is veterans 

will appeal, the backlog will eventually grow, and we will be facing 

this over again. 

I wish to commend the Under Secretary General Hickey for her 

commitment to the fully developed claim program. I think it is the 

best thing that the VA has tried in over 40 years and I encourage 

it. 

We suggest the following: the VA work measurement system, 

which encourages people to prematurely adjudicate claims, has to 

be overhauled even if Congress has to pass a law. The VA needs 

more people to work these claims. In spite of electronic this, and 

lanes, and all the other things the VA is trying to do, which is a 

good thing, they do not have enough people. They need more people 

to work the claims. 


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And finally the adjudication culture at the VA needs to be 

changed. Many VA managers that we have met on our travels unfortunately act like they are producing widgets rather than adjudicating claims filed by real people. You saw the real people here 

today. Their goal should not be prompt adjudication. The goal 

should be a timely, accurate, and fair adjudication. Which in the 

long run, not in the short run, is the best way to finally adjudicate 

claims and reduce the backlog. Thank you. 

PREPARED STATEMENT OF RONALD ABRAMS 

Mr. Chairman and Members of the Committee: 

I am pleased to have the opportunity to submit this testimony on 

behalf of the National Veterans Legal Services Program (NVLSP). 

NVLSP is a nonprofit veterans service organization founded in 

1980 that has been assisting veterans and their advocates for over 

thirty years. We recruit and train volunteer attorneys, service officers from such veterans service organizations as The American Legion, the Military Order of the Purple Heart and the Military Officers Association of America in veterans benefits law, and conduct 

quality reviews of VA regional offices on behalf of The American 

Legion. NVLSP also represents veterans and their families on 

claims for veterans benefits before VA, the U.S. Court of Appeals 

for Veterans Claims (CAVC), and other federal courts. Since its 

founding, NVLSP has represented thousands of claimants before 

the Department of Veterans Affairs (VA) and the Court of Appeals 

for Veterans Claims (CAVC). NVLSP is one of the four veterans 

service organizations that comprise the Veterans Consortium Pro 

Bono Program, which recruits trains and mentors volunteer lawyers to represent veterans who have appealed a Board of Veterans’ 

Appeals decision to the CAVC without a representative. NVLSP 

has written educational publications, such as the Veterans Benefits 

Manual (VBM), that thousands of veterans advocates regularly use 

as practice tools to assist them in their representation of VA claimants. 

WHAT ARE COMPLEX DISABILITY CLAIMS 

In general there are three types of complex claims: 

* some claims, by their very nature, are very complicated; 

* some claims can become complex as they are developed by VA 

or as evidence from the claimant is submitted; and 

* some claims can become complex because of VA error. 

Inherently Complicated Claims 

Claims involving entitlement to special monthly compensation 

(SMC) and claims involving the evaluation of traumatic brain injury or mental conditions can be very complicated. (In fact, the regulation dealing with the evaluation of traumatic brain injury (TBI) 

is so complicated that some VA adjudicators call it the ‘‘Da Vinci 

Code.’’ (38 C.F.R. § 4.124(a), DC 8045).) Other inherently complicated claims include, but are not limited to, the evaluation of 

joint conditions (see DeLuca v. Brown 8 Vet. App. 202 (1995); 

claims for service connection for PTSD (includes claims for PTSD 

based on military sexual trauma (MST)); claims for secondary service connection; claims for service connection based on presumption 


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(see 38 U.S.C. § 1101(3) and 38 C.F.R § 3.309(a) (2013); and claims 

for increase for a service connected back disability. 

Claims That Can Become Complicated 

Most claims for service connection have the capacity to become 

very complicated. Let me give you a few examples: 

A. Let us talk about what appears to be a simple claim for service connection for an arthritic joint condition (back, knee, shoulder, 

ankle). Many veterans support their claims for an arthritic condition by saying that they suffered from pain ever since discharge. 

In many instances there is no objective evidence of complaint or 

treatment of an arthritic problem in service. Some VA adjudicators 

deny such claims. These denials are wrong because this action constitutes a premature denial. If the duty to assist is triggered (38 

U.S.C. § 5103A), the VA is obligated to further develop the claim 

to determine if the joint condition manifested to a degree of ten 

percent within one year of discharge (see 38 C.F.R. §§ 3.307 and 

3.309(a)). The VA would be obligated to invite the veteran to submit lay and medical evidence that would tend to support the conclusion that the joint condition manifested to a degree of ten percent within the presumptive period and medical evidence linking 

the current disability to the symptoms identified within the first 

year after discharge. While medical evidence would be helpful, lay 

evidence alone can be enough to support the finding that a joint 

condition manifested to a compensable degree within the first year 

after discharge. Generally, a medical opinion would be required to 

link the veteran’s current joint disability to the symptoms suffered 

within the presumptive period. If service connection was granted, 

the VA would have to establish the proper effective date and evaluate the severity of the disability. These issues can also be complicated. 

B. Most claims involving entitlement to high levels of special 

monthly compensation (SMC) are inherently very complicated. Recently NVLSP worked on a claim for benefits that dealt with entitlement to SMC. 

a. The veteran was shot in the head while on a combat mission 

in Iraq. As a result of his injuries, surgeons removed part of his 

brain and skull. In total, he had undergone over thirteen surgical 

procedures and had been a patient at six military and civilian medical centers and continued to suffer on a daily basis from the devastating effects from his tragic injuries. 

b. The VA issued an initial Proposed Rating on March 7, 2011 

(the veteran at that time, was still in service waiting to be discharged) which acknowledged eighteen different service-connected 

disabilities. These disabilities included residuals of traumatic brain 

injury (100%), a gunshot wound to the face (80%), and loss of half 

of the visual field in each eye (50%). The initial rating also awarded special monthly compensation at the (l ‡) level based on the 

need for aid and attendance (l), combined with a separately rated 

disability greater than fifty percent (‡). The VA also established entitlement to SMC ratings under 38 U.S.C. § 1114(k), for loss of use 

of the right foot, and one for loss of use of a creative organ. 

c. On April 5, 2011, the VA issued a second proposed Rating. 

This rating established entitlement to SMC M. Underlying this 

proposed special monthly compensation rating was the veteran’s 


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need for aid and attendance (l), combined with additional, separately rated disabilities of the same etiology rated at 100% or more 

(next higher rate, to (m)). These separately rated disabilities include: gunshot wound to the left face, right eye, seizure disorder, 

scars, adjustment disorder, temporomandibular joint disorder, left 

ear hearing loss, tinnitus, loss of smell and taste, and seventh cranial nerve dysfunction. 

d. A law firm, assisted by NVLSP, (the law firm represented the 

veteran on a pro bono basis) argued that the evidence of record 

supported a higher level of SMC because he has (a) the loss of use 

of both his right hand and right foot, (b) the need for regular aid 

and attendance due to other independent disabilities, and (c) the 

additional need for a higher level of aid and attendance without 

which he would require residential institutional care. 

We argued that for the reasons stated below, the veteran was entitled to compensation under 38 U.S.C. § 1114(r)(2). 

e. First, under 38 C.F.R. § 4.71a and Diagnostic Code 5111, the 

veteran is entitled a 100% schedular evaluation based on loss of 

use of both a hand and a foot. 

f. Second, he is also entitled to special monthly compensation 

benefits under 38 U.S.C. § 1114(l) due to the loss of use of both his 

right foot and right hand (38 C.F.R. § 3.350(b)). (The VA acknowledged the loss of use of the right foot.) In addition, as a result of 

his traumatic brain injury he also has functional loss of use in his 

right hand. 

g. Third, he is also entitled to special monthly compensation benefits under 38 U.S.C. § 1114(l), based on service-connected disabilities unrelated to his loss of use of his right foot and right hand, 

that cause him to need regular aid and attendance. The gunshot 

wound to his head triggered a full range of other disabilities independent of his hand and foot, including but not limited to seizures, 

vertigo, loss of vision, loss of hearing, cognitive difficulties, mild 

loss of memory, trouble swallowing, and partial paralysis in the 

face. 

h. Fourth, because there are two separate, unrelated special 

monthly compensation ratings under subsection (l), the veteran is 

entitled to special monthly compensation benefits under § 1114(o). 

Further, his entitlement to compensation under subsection (o) combined with his need for regular aid and attendance require that VA 

grant him, at a minimum, a rating under § 1114(r)(1). 

i. Fifth, considering the full range of his service-connected disabilities that resulted from him being shot in the head, he requires 

an even higher level of care than regular aid and attendance under 

subsection (r)(1). As the record indicates, the veteran would require 

residential institutional care without daily personal health care 

services in his home, supervised by a licensed professional. VA 

should therefore grant the veteran a special monthly compensation 

rating pursuant to subsection (r)(2). 

j. Also, it appears that when § 1114(t) becomes effective the veteran will be entitled to special monthly compensation benefits 

under subsection (r)(2) even without proving any need for daily personal health care services in the home. (§ 1114(t) became effective 

on October 1, 2011 after the date of this submission). 


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k. Happily, before the injured service member was discharged, 

the VA awarded benefits at SMC(r)(2) rate. 

l. In this case, the excellent brief was not enough. When the VA 

delayed in granting this claim I asked for an explanation. I was 

told that in order for the VA to grant SMC(r) the evidence needed 

to show loss of bowl and bladder control. I was able to reach the 

supervisor of this VA component and took her through the entire 

process. Eventually she agreed with our analysis. 

m. This severely wounded veteran need the help of a major law 

firm and NVLSP to obtain, within a reasonable time, the proper 

level of benefits. Not every veteran has access to these resources. 

Therefore, it would be better for all veterans if VA raters could 

learn the complicated VA rules. 

C. VA errors can make simple claims complicated. For example, 

suppose a veteran claims service connection for PTSD. The alleged 

stressor or traumatic event is exposure to combat. In some cases 

a VA regional office schedules a VA examination (asking the doctor 

to determine whether the veteran suffers from PTSD and to opine 

as to whether the current PTSD is linked to a stressful event in 

service. In too many cases, the VARO does not take the time to review the record in order to tell the examiner whether or not the 

veteran was exposed to a stressor in service. That is a decision VA 

adjudicators must make. Because some VA examiners will not diagnose PTSD unless they identify an in-service stressor they provide a negative report to the VA (38 C.F.R. § 3.304(f)). Therefore, 

the claim for PTSD would be denied. If the veteran had a Combat 

Infantry Badge (an award that shows combat with the enemy), the 

negative medical opinion would be meaningless. In many cases, 

after this error, the veteran would have to appeal to the BVA or 

the CAVC. This could take years. A simple claim would turn into 

a nightmare. 

THE NON–ADVERSARIAL VA CLAIMS ADJUDICATION 

PROCESS 

First, I want to stress the obvious. Complex claims for VA disability benefits have a higher error rate than simple claims. 

As far back as 1991 the US Court of Appeals for Veterans Claims 

(CAVC) held that ‘‘Rather than defending against the claims of veterans, the Secretary has a statutory duty to assist claimants during the course of the ex parte and non-adversarial claims resolution 

process at the regional office and before the BVA.’’ Manio v. 

Derwinski, 1 Vet. App. 140, 144 (1991). Under 38 C.F.R. § 3.103(a) 

(2013) ‘‘Proceedings before VA are ex parte in nature, and it is the 

obligation of VA to assist a claimant in developing the facts pertinent to the claim and to render a decision which grants every benefit that can be supported in law while protecting the interests of 

the Government.’’ 

Based on the experience of NVLSP, the most egregious VA errors 

are a result of premature adjudications. For example, the errors we 

have identified reveal that VA adjudicators failed prior to issuing 

an initial rating decision, even to try to satisfy the VA statutory 

duty to assist the claimant by obtaining the evidence needed to 

substantiate the claim. The VAROs incorrectly adjudicated and 


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prematurely denied claims based on inadequate evidence (especially inadequate VA medical examinations). 

Over the past 15 years, I have traveled to many VA regional offices as part of a quality review team for The American Legion. I 

have personally visited over 40 VA regional offices, some more than 

once. My job, as part of the Legion team, was to check the quality 

of adjudications at the various VA regional offices. The Legion 

should be commended for spending the time and money to do these 

reviews. Prior to that time, when I worked for the VA part of my 

time was spent in what was then called Statistical Quality Review 

(essentially VA Central Office quality review). Working for the 

Compensation and Pension Service, we checked the quality of adjudications in all VA regional offices (ROs). In addition, I currently 

review and approve or reject many BVA decisions that an NVLSP 

attorney proposes that we appeal to the CAVC. Based on that combined experience and based on the entirety of my work for NVLSP. 

I can tell you the following: 

* The current error rate is somewhere between 30 and 40% (in 

some ROs it is higher). For example, the Legion quality review 

team identified errors in 35% of the cases in Indianapolis; 64% of 

the cases in Baltimore had errors; 31% of the cases reviewed in 

Nashville had errors; and 64% of the cases reviewed in Oakland 

had errors. (In the Legion reports errors were described as problems or comments.) 

* It is unrealistic to assume that the accuracy rate at the VA regional offices will ever approach 98%. Please note that over 70% of 

claims appealed to the BVA are reversed or remanded and over 

70% of BVA decisions appealed to the CAVC are reversed or remanded. I should also note that NVLSP obtains a reversal or remand in over 90% of the cases it takes to the CAVC. 

* Many claims that should be adjudicated (or at least invited) are 

ignored by VA adjudicators. The VA Claims Adjudication Manual 

(M21–1MR) makes it clear that when preparing a decision, the VA 

regional office adjudicator must recognize, develop, and/or decide 

all issues, whether: expressly claimed, implied, informal, potential, 

mandated, or ambiguous. (See M21–1 MR PART III, Subpart IV, 

Chapter. 6, Section 2.B.2 a. Recognizing Issues When Preparing a 

Decision.) 

* The most common errors are: 

– premature denials based on inadequate development; 

o under evaluation of mental conditions; 

o under evaluation of joint disabilities; 

o failure to consider presumptive service connection; and 

o failure to inform VA medical examiners what facts have been 

accepted as true by VA adjudicators. (If the VA examiner does not 

know that a fact must be accepted as true then the medical opinion 

may be worthless because the VA examiner may provide an opinion 

based on the wrongful premise that the veteran’s statement is not 

accurate because it is not supported by other evidence of record.) 

As you know, there is always tension between quantity and quality. In fact, faced with a growing backlog caused by a surge of 

claims from OIF and OEF veterans and with the compounded impact of many years of premature adjudications that forced claimants to appeal or file reopened or repeat claims, the issue of quanVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00042 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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tity vs. quality has gained increased importance. Unfair, premature 

denials cause unnecessary appeals and years of delay before deserving veterans obtain justly earned benefits. Adjudicating many 

claims quickly does no good if many of these adjudications are premature and many deserving veterans are unfairly denied. Many 

veterans will appeal and the overall backlog will simply grow. 

The most important and pervasive problem facing veterans seeking VA disability benefits is the eagerness of some VAROs to adjudicate claims before all necessary evidence has been obtained. This 

is especially true for complex claims. For example, some VAROs 

prematurely deny claims based on inadequate VA examinations. In 

some cases, even where the VA examiner clearly fails to respond 

to a specific question asked by the RO, the examination report is 

not returned as inadequate. Instead, the claim is adjudicated and 

denied on the basis of the inadequate report. In other instances, 

claims are denied before all service medical records are received. 

Other claims are sometimes denied before the veteran has a fair 

opportunity to submit independent medical evidence. These all-toofrequent cases of premature denial result from an over-emphasis on 

timeliness and a lack of accountability. 

It is clear to NVLSP that the way the VA evaluates its adjudicators and the way the VA awards work credit encourages sloppy adjudication resulting in premature, unfair denials. Therefore, the 

first thing those who manage the VA need to do is to admit there 

is a real and very serious problem with the quality of VA adjudications. NVLSP believes that the problems within the VA claims adjudication system are so serious that recent innovations such as 

paper-free or electronic claims processing, and different ‘‘lanes’’ for 

specific types of claims, while helpful, will not be enough to fix the 

problem. 

Potential Solutions 

I wish to commend the Under Secretary for Benefits, General Allison A. Hickey, for her commitment to the Fully Developed Claim 

(FDC) program. This FDC initiative could be the best thing the VA 

has attempted in the last 40 years. 

That said, the VA work measurement system has to be overhauled so that there is a balance between quality and quantity. 

Also, the VA needs to acknowledge the complexity of its claims adjudication system and continue to increase the number of adjudicators to work these claims. At the current time, based on my 39 

years working in veterans law and especially my quality review experience, I can confidently say that most regional office need more 

workers just to keep up with the current workload. More adjudicators are desperately needed if the backlog is to be reduced and initial claims and appeals are to be accurately adjudicated within a 

reasonable amount of time. 

The following suggestions should be considered: 

1. The VA should be required to submit to an independent quality review to validate the quality of work performed in the individual VA regional offices. 

2. The pay grade levels of VA raters and Decision Review Officers should be raised on the condition that these employees are 

held accountable for the quality of their work (rewards for accurate 


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prompt adjudications, and adverse personnel action for unacceptable levels of quality). 

3. Congress needs to continue to provide additional funding for 

more adjudicators. 

4. Adjudicating from electronic records is a laudable goal if complete records can be obtained and if the database permits logical 

searches. 

5. Finally, the adjudication culture at the VAROs needs to be 

changed. Many VA managers unfortunately act like they are producing widgets rather than adjudicating claims filed by real people. 

Their goal should not be just prompt adjudication; the goal should 

be a timely, accurate and fair adjudication – which in the long run 

is the fastest way to finally adjudicate claims. I want to note that 

the current VA management is trying to do this but more needs to 

be done. 

NVLSP is not demanding perfection from VA managers and adjudicators. NVLSP, however, feels that unless the adjudication culture is changed, unless the VA can hire more adjudicators and unless the VA changes the way it counts its work, there will be no 

significant improvement. 

Executive Summary 

In general there are three types of complex claims: 

(1) some claims, by their very nature, are very complicated; (2) 

some claims can become complex as they are developed by VA or 

as evidence from the claimant is submitted; and (3) some claims 

can become complex because of VA error. 

Examples 

(1) Inherently complicated – claims involving special monthly 

compensation; (2) claims that can become complicated such as 

claims for direct and presumptive service connection; and (3) claims 

that VA errors make complex (claims that are not properly adjudicated and prematurely denied). 

Non-Adversarial claims adjudication process 

(1) Complex claims have a higher error rate; (2) there is an ex 

parte and non-adversarial claims resolution process at the regional 

office and before the BVA; (3) the most egregious VA errors are a 

result of premature adjudications; (4) the current error rate is 

somewhere between 30 and 40%; (5) it is unrealistic to assume that 

the accuracy rate at the VA regional offices will ever approach 98%; 

(6) many claims that should be adjudicated (or at least invited) are 

ignored by VA adjudicators; 

The most common errors are: 

(1) premature denials; (2) under evaluation of mental conditions; 

(3) under evaluation of joint disabilities; (4) failure to consider presumptive service connection; and (5) failure to inform VA medical 

examiners what facts have been accepted as true by VA adjudicators. 

Solutions 

(1) The VA should be required to submit to an independent quality review; (2) 


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Make VA raters and Decision Review Officers accountable for the 

quality of their work; (3) Hire more VA adjudicators; and (4) The 

adjudication culture at the VAROs needs to be changed. 

Mr. RUNYAN. I thank the gentleman. And with that, I know we 

have pending votes on the floor but we may get to questions after 

Mr. Hearn does this. If not we will go into recess and we will come 

back afterwards. So Mr. Hearn, you are now recognized for your 

testimony. 

ORAL STATEMENT OF ZACH HEARN 

Mr. HEARN. Good afternoon, Mr. Chairman, Ranking Member 

Titus, and members of the committee. We are here to talk about 

the implementation of special operations lanes. VA created these to 

address accuracy. What we never talk about, though, is why accuracy matters. 

VA estimates they will process over a million claims again this 

year. The difference between their goal of 98 percent accuracy and 

even 97 percent is over 10,000 veterans who may not get the benefits they earn. We all know the real gap in accuracy is far more 

than one percent, as well. We are talking every year a small city 

in America full of veterans who may not get the benefits they earn 

through their hard years of service. Each of those veterans is a 

story and a family too, unique in its own way like the stories we 

just heard from the first panel. That is why the American Legion 

is constantly raising the importance of accuracy. Because for all 

those veterans who wind up on the wrong end of those errors VA’s 

accuracy rate may as well be zero. 

Why are there still problems? It is a complicated system. It does 

take experience and attention to detail to get things right. Putting 

experienced personnel on the tougher claims is a good start. When 

VA has the ability to ensure this is consistently applied across the 

country with the right personnel to execute this plan it will probably help with improving the figure. But there are still some system problems which hamper VA’s ability to get it right for veterans. 

I have been fortunate to travel to many VA offices as part of the 

American Legion’s regional office action review program. For over 

15 years we have been conducting these week-long intensive visits 

to VA offices to review claims and assess VA accuracy, and to see 

inside the offices outside the Beltway and get a true picture of how 

the implementation works in the field. Through these visits we 

have seen patterns. For example, consistency from one office to another office leaves much to be desired. Policies embraced by leadership in one office may be given lower priority in other offices. And 

with mixed commitment you get mixed results. 

VA also seems to struggle with finding the right balance of development for claims, which leads to adjudication errors. You cannot 

build a house on a shaky foundation. On our review visits we examine a sample of dozens of recently adjudicated claims for veterans the American Legion represents. Often the claim has either 

been underdeveloped or overcomplicated. Both of these early errors 

are a recipe for later errors later in the process. 

VA has a tendency to under develop claims and leave adjudicators with too little information to make a fair judgment on service 


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connection or rating. For example, in April, 2013 we visited the 

Nashville Regional Office. According to the April 27th Monday 

morning workload report Nashville had a 95 percent accuracy rating for the previous three months. During the review of 22 cases 

we found 11 where we commented regarding case development to 

include seven with errors. 

Our review paints a far dimmer picture of Nashville’s accuracy 

than indicated in the workload report. In one case a veteran was 

seeking service connection for PTSD. Evidence within the file obtained from a VETS Center indicated the veteran served in the 

Persian Gulf during Desert Storm and was chronically fearful of 

death due to chemical warfare. Additionally, the VETS Center 

exam noted treatment for symptoms associated with PTSD in service and at the time of the VETS Center exam had extensive symptoms associated with PTSD. No exam was provided by VA. A rating 

decision denied the veteran service connection for the condition due 

to a lack of diagnosis. Yet if a veteran exhibits symptoms of a condition a VA compensation and pension exam should be afforded. 

The veteran exhibited symptoms that should have triggered an 

exam. An exam was never scheduled and instead VA opted to simply deny the veteran benefits without due process. 

Conversely sometimes VA does not seem to know when to stop 

and overcomplicates a claim. In June we visited the Reno RO. The 

June 3rd workload reports indicate they had a 93.2 percent accuracy rating. Our review of cases resulted in comments regarding 

the adjudication of 59 percent of reviewed claims for VA benefits. 

In one instance a veteran was seeking service connection for PTSD. 

During a July, 2011 VA C&P exam the examiner linked the veteran’s condition to military service. The regional office returned the 

exam results in August, 2011 to the examiner to again restate his 

opinion and again the examiner stated the veteran’s PTSD is related to service. After the second review VA finally adjudicated the 

benefit in September, 2012 and sent the notice letter in January, 

2013. VA conducted two exams but only one was necessary and it 

took over two years from the date of the first exam to adjudicate 

the claim, and then another four months to notify this veteran. 

The American Legion believes these problems could be mitigated 

by adopting some strategies our National Commander Dan 

Dellinger advocated for during his testimony before Congress this 

fall. Fixing the work credit system that currently places more emphasis on actions completed than actions done right; aggregating 

common errors to develop a training plan; these are steps we want 

to see taken. Fixing the accuracy problem needs to start with the 

right mind set. The mind set should not be achieving 98 percent 

accuracy. The mind set needs to be I need to get every step right 

for this veteran. Until the problem gets fixed we are losing the 

good faith of a city of veterans every year. 

Thank you and I will be happy to take questions. 


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PREPARED STATEMENT OF ZACH HEARN 

According to a February 2013 Congressional Research Service 

(CRS) report, service members have either suffered or have been 

diagnosed with the following complex conditions from 2000–20121: 

* 131, 341 diagnosed with posttraumatic stress disorder (PTSD) 

* 253,330 diagnosed with traumatic brain injury (TBI) 

* 1,715 underwent amputations due to service in Iraq and Afghanistan 

The Department of Veterans Affairs (VA) states 20 percent of 

women and one percent of men indicate they suffered military sexual trauma (MST) in service2. VA defines MST as ‘‘any sexual activity where you are involved against your will.’’ A May 2013 Associated Press article indicates in 2012, more than 85,000 veterans 

sought treatment due to injuries or diseases resulting from MST; 

4,000 sought VA disability benefits as a result of the condition3. 

The nature of conditions such as PTSD, TBI, MST and claims 

that require special monthly compensation (SMC), are often complex in nature and require a deeper understanding of VA disability 

benefits than many other types of VA disability claims. In order to 

achieve Secretary Eric Shinseki’s laudable goal of 98 percent accuracy on all claims by 2015, VA needed to take measures to ensure 

these complex claims were handled by people experienced and expert enough to reduce the risk of error. 

To this end VA established segmented lanes in each of its regional offices designed to provide a specialized approach to claims’ 

adjudication depending on the nature of the claim or the manner 

that the veteran or dependent sought disability benefits. The tough 

claims would be developed and adjudicated in the ‘‘special operations’’ lane with senior VA raters adjudicating these complex 

claims. 

In concept, this practice of putting the best, most experienced 

personnel on the task of adjudicating the most difficult claims is 

laudable and logical. The American Legion supports and even utilizes the idea of ensuring newer, less experienced employees handle 

simpler, more straightforward claims while experienced hands do 

the heavy lifting on the more complicated and sensitive claims. 

The American Legion has conducted Regional Office Action Review (ROAR) visits to VA Regional Offices (VAROs) for over 15 

years, performing quality review oversight and evaluating work 

procedures during an intensive weeklong process. Recognizing The 

American Legion’s expertise in this area as the only Veterans’ 

Service Organization with so comprehensive a review process, the 

White House contacted The American Legion to coordinate an evaluation of the Fully Developed Claims (FDC) program over 2012 

and 2013. These visits were performed in conjunction with the 

White House, Joining Forces, VA Central Office officials, and later 

with Disabled American Veterans (DAV) as the program expanded. 

The American Legion had the opportunity to visit eight VAROs 

beginning in December 2012 and concluding in June 2013 during 

the implementation phase of the FDC program. In addition to examining the FDC program, American Legion experts discussed 

issues surrounding FDC with VA raters and senior staff, to include 

the implementation of the segmented lanes by VA. As always with 


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ROAR visits, recently adjudicated claims under American Legion 

Power of Attorney (POA) were reviewed by Legion staff and Legion 

accredited attorneys contracted through the National Veterans 

Legal Services Program (NVLSP) to gauge VA’s accuracy and check 

for adjudication and development errors. 

Unfortunately, during these visits, it became clear through discussion with senior VARO staff that experienced staff is at a premium. Much of the staff has less than five years experience and 

may not have either the experience or knowledge base to accurately 

adjudicate complex claims. While the concept of the ‘‘special operations’’ lanes is still sound, performance in individual VAROs may 

be inconsistent, because the experience base necessary to implement the plan may not exist. 

Developing statistics on VA’s current accuracy rating regarding 

complex claims such as PTSD, TBI, MST, and claims that involve 

SMC presents a challenge. While VA’s Monday Morning Workload 

Report includes VA’s accuracy for claims’ adjudication, it fails to include accuracy ratings for the types of claims adjudicated; therefore 

it is difficult to determine whether this approach is helping improve the adjudication of these special claims. 

Furthermore, VA’s accuracy statistics from the Monday Morning 

reports are not consistent with the review of recently adjudicated 

claims as conducted by the American Legion ROAR teams. When 

visiting VAROs over the past year, ROAR staff reviewed 260 claims 

adjudicated by the VAROs. Of those 260 claims, 55 percent were 

identified as having errors, particularly regarding the development 

of the claim. This statistic is in stark contrast to the approximate 

90 percent accuracy rating in claims’ adjudication indicated by VA’s 

Monday Morning workload reports. 

For conditions such as PTSD and TBI, it is not simply the accurate adjudication of the individual condition that veterans face but 

also the conditions that may have either manifested secondary to 

either PTSD or TBI or were aggravated by the conditions. 

Cardiovascular, gastrointestinal and musculoskeletal conditions 

have been identified as being possibly related to PTSD4; yet The 

American Legion’s national appeals representatives at the Board of 

Veterans’ Appeals (BVA) routinely have claims remanded by BVA 

due to VA’s failure to consider the relationship of condition such as 

hypertension and gastro esophageal reflux disease (GERD) to 

PTSD. This is particularly frustrating given the support for this 

link is in VA’s PILOT database for PTSD. 

When VA is not under-developing claims, they can be prone to 

over complicating claims that should be simple. 

The American Legion’s network of over 2,900 accredited service 

officers often come across claims needlessly delayed while VA continues to seek additional records for conditions already adequately 

reflected in the record, or orders extraneous exams long after medical examinations have connected a current condition to the veteran’s service and displayed the level of disability to a degree sufficient to enable rating the claim. These needless exams and record 

searches can add months or even years to a veteran’s wait times. 

In order to achieve 98 percent accuracy, The American Legion believes VA must develop a full understanding of the strengths and 

weaknesses of its adjudicators and the common errors commitment 


VACREP180 with DISTILLER
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systemically in the claims system. The American Legion believes 

through the data able to be tracked in the VBMS system, decisions 

of the Court of Appeals for Veterans Claims (CAVC), the Appeals 

Management Center (AMC) and the BVA, VA is sitting on a 

goldmine of data about where they can work to improve accuracy, 

yet this goldmine remains untapped. The American Legion would 

like to see VA develop a system to analyze the vast trove of error 

information, track it, and use it to develop training to improve results. In short, to ensure the highest reward for the training investment, VA should identify areas that training is required for its raters and provide specific training based upon the nature of the claim 

or condition and the identified common errors with those types of 

claims. 

When The American Legion asked VA if they were tracking these 

statistics internally, VA responded: ‘‘We currently do not post or 

provide quality data based solely on diagnostic codes.’’ If VA is collecting data on accuracy of adjudication based upon diagnostic 

code, it would be helpful for determining the success of programs 

such as the ‘‘Special Operations’’ lanes if this data was released for 

public review. 

The American Legion believes VA should provide better information regarding VA disability claims in a public venue5. Veterans 

and their families should have the opportunity to know the accuracy of adjudications. 

As the individual conditions treated by the ‘‘special operations’’ 

lanes are considered, The American Legion is deeply concerned not 

only about the statistics and effects of MST, but also the manner 

that claims associated with MST are adjudicated. As disturbing as 

the statistics regarding MST are, the manner in which the claims 

are adjudicated is equally disturbing. A fact sheet published by VA 

states6: 

Department of Defense forms used in reporting incidents of sexual assault or harassment, as well as investigative reports during 

military service are direct evidence to support these claims. However, VA knows that events involving personal assault or sexual 

trauma are not always officially reported. Therefore, VA has relaxed the evidentiary requirements and looks for ‘‘markers’’ (i.e., 

signs, events, or circumstances) that provide some indication that 

the traumatic event happened, such as 

* Records from law enforcement authorities, rape crisis centers, 

mental health counseling centers, hospitals, or physicians. 

* Pregnancy tests or tests for sexually transmitted diseases. 

* Statements from family members, roommates, fellow service 

members, clergy members, or counselors. 

* Request for transfer to another military duty assignment. 

* Deterioration in work performance. 

* Substance abuse. 

* Episodes of depression, panic attacks, or anxiety without an 

identifiable cause. 

* Unexplained economic or social behavioral changes. 

* Relationship issues, such as divorce. 

* Sexual dysfunction. 

In July 2010, VA changed its regulations regarding the evidentiary requirements for veterans seeking disability for PTSD. ReVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00049 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

VACREP180 with DISTILLER
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alizing that veterans were often facing difficulties providing 

stressor statements that could not be corroborated by VA, VA simplified the adjudication through ‘‘eliminating this time-consuming 

requirement where the claimed stressor is related to ‘fear of hostile 

military or terrorist activity,’ is consistent with the places, types, 

and circumstances of their service, and a VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the 

claimed stressor is adequate to support a diagnosis of PTSD.7’’ 

Considering the negative attention the Department of Defense 

has received regarding the manner that it investigates and takes 

appropriate actions regarding MST incidents and the number of incidents unreported to authorities, it is plausible a veteran who was 

the victim of MST would not have the necessary evidence as indicated in VA’s fact sheet regarding the adjudication of these claims 

to support the granting of a disability benefit associated with MST. 

Realizing that latitude should be afforded to veterans who were 

MST victims, The American Legion urges VA to ‘‘apply reduced criteria to MST-related PTSD to match that of combat related 

PTSD.8’’ 

It’s time to treat the survivors of this horrible crime the same 

way we treat the survivors of war. 

Developing a plan to improve accuracy is essential because it has 

a definite and measurable impact on the lives of veterans. It is 

sometimes difficult to put the importance of accuracy in perspective, and to realize the scope of the impact of accuracy on these 

claims, consider the following statistics. As previously noted, the 

February 2013 CRS report indicated 386,386 servicemembers diagnosed with PTSD, TBI, and/or amputations. If each veteran diagnosed with these conditions sought service connection, even utilizing VA’s favorable 90 percent adjudication accuracy rating, 

38,638 veterans would either not be receiving service connected disability compensation or would be underrated for these conditions. 

If the accuracy of these claims were closer to the accuracy levels 

documented by The American Legion in the past 12 months during 

ROAR visits, over 212,000 veterans – roughly the size of Reno, 

Nevada9 – would either not be receiving service connected disability compensation or would be underrated for these conditions. 

For those veterans, VA’s accuracy rate might as well be zero. 

Veterans suffering from PTSD, TBI, amputations, or MST are 

often the most vulnerable veterans. Mobility, employment, and 

treatment are just some of the many issues that these veterans 

may face. With denial of these benefits, the opportunity for VA 

health care may not exist. Furthermore, denial of these benefits 

could exclude veterans from additional benefits they are entitled to, 

such as federal hiring preference and elimination of the VA funding 

fee for VA mortgages and VA will have failed to honor Abraham 

Lincoln’s call ‘‘to care for him who shall have borne the battle and 

for his widow, and his orphan’’. 

On behalf of our National Commander Daniel M. Dellinger, and 

our 2.4 million members, The American Legion thanks this subcommittee for their diligent attention to the disability benefits 

process. The American Legion will be watching closely, and hopes 

to work closely with both VA and Congress to ensure the ultimate 

outcome is in the veterans’ best interest. 


VACREP180 with DISTILLER
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For any questions regarding this testimony please contact Ian de 

Planque, Deputy Legislative Director of The American Legion at 

(202) 861–2700 or ideplanque@legion.org 

1 CRS Report for Congress, U.S. Military Casualty Statistics: Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom (Washington, D.C., February 2013), pp. 5–10. 

2 http://www.ptsd.va.gov/public/pages/military-sexual-traumageneral.asp 

3 http://www.nydailynews.com/news/politics/military-sexual-assaults-heavy-toll-veterans-article-1.1349140 

4 http://www.ptsd.va.gov/professional/pages/ptsd-physicalhealth.asp 

5 Resolution 99: Increase the Transparency of the Veterans Benefits Administration’s (VBA) 

Claims Processing, - AUG 2012 

6 http://www.benefits.va.gov/BENEFITS/factsheets/ 

serviceconnected/MST.pdf 

7 http://www.va.gov/PTSD—QA.pdf 

8 Resolution 295: Military Sexual Trauma, - AUG 2012 

9 http://quickfacts.census.gov/qfd/states/32/3260600.html 

———————- 

——————————————————————————————— ——————————————————————————————— 

———————- 

——————————————————————————————— ——————————————————————————————— Mr. RUNYAN. Thank you, Mr. Hearn. And seeing that there is 

probably less than five minutes left on the clock on the floor, we 

are going to have to go into recess, and be back in half an hour 

to 40 minutes. So as of now the committee stands in recess. 

[Recess.] 

Mr. RUNYAN. The subcommittee will come to order and we will 

begin a round of questioning and I will start that off. And my first 

question will be for Mr. Abrams. You note in your written testimony that one manner in which claims become complex is because 

of VA error. Cases of this sort are often appealed and then remanded, often more than once, further increasing the complexity of 

the claim procedurally. Number one, can you elaborate on the common types of errors you see which causes claims to become more 

complex due to VA error on appeal? And number two, do you think 

that greater focus on appealed and remanded claims would assist 

VA in learning from its mistakes and making less of these types 

of errors in the future? 

Mr. ABRAMS. Yes, I can. Let me give you an example. Suppose 

a veteran files a claim for PTSD. The veteran alleges that he suffered a stressor when exposed to combat. The veteran’s service 

records show a combat infantry badge, which means the veteran 

was in combat. However, the VA in an effort to go fast sets up an 

examination and fails to tell the medical examiner to accept as true 

the fact that the veteran was exposed to combat. The VA examiner 

looks at the file, does not see any evidence of a stressful incident 


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in service, does not know how to read a DD–214, and determines 

that he could not diagnose PTSD without a stressor. Therefore he 

writes a negative medical opinion and diagnoses the veteran with 

anxiety disorder or something like that. The VA then denies the 

claim. To resolve that claim could take five to eight years. And the 

VA needs to take the time at the start, this is just a simple error, 

I could get into complicated ones and we would be here much too 

late. But that is a simple error that can be fixed if the VA takes 

the time at the start to tell the doctor what evidence to accept as 

true. That is not for the doctor to determine, that is for the adjudicator, the VA adjudicator to make that, you know, finding. 

Your second question was if they got more involved, I am not 

sure what you mean by more involved? With remands? 

Mr. RUNYAN. If they paid closer attention to the process. 

Mr. ABRAMS. Well they should. They need to analyze the types 

of remands that come back from the Board and take action to train 

on that. We certainly look at thousands of cases a year and we 

keep a list of the common errors that the VA makes that we can 

win at the Court for. And in my testimony we listed some of those 

that you can see. But I am hoping that the VA does that. I am not 

sure that they do. 

Mr. RUNYAN. Thank you. And again for Mr. Abrams, and Mr. 

Gillums maybe, you both provided examples in your written testimony of issues with VA adjudicators properly calculating the 

amount of special monthly compensation for severely disabled veteran. Why do you think that calculating SMC is so problematic for 

VA adjudicators? 

Mr. ABRAMS. Do you want me to answer that first? 

Mr. RUNYAN. Please. Yes, please. 

Mr. ABRAMS. First of all in my experience, and I think you have 

staff members who have traveled to, you know, ROs that have seen 

this too, SMC is inherently a complicated issue. Second, there are 

some things that the VA looks for magic words for that are not 

there. In the case I wrote about in my testimony the veteran’s military doctor said he had lost all function in his right hand and he 

had lost the use of his right foot. The VA did not conceded loss of 

use of the right hand because the doctor did not say the magic 

words. When we contacted the doctor the doctor changed his written comments and said he had lost the use of the right hand. Well 

loss of use of a right hand and loss of use of a foot generates an 

L, SMCL. He already had an L because he was in need of A&A because his traumatic brain injury. This is a man who was shot in 

the head in Iraq, had 18 service-connected conditions, operates on 

a grade-school level, has tubes in his head that fluid comes out of, 

has terrible scars on his face, lost the sense of taste and smell, and 

is, you know, has suffered tragic wounds. I got involved because I 

wanted to help this guy. My heart went out to him. And even after 

we produced clear evidence that he should get SMCR2, slam dunk, 

the VA did not act. So I finally was able to reach the component 

of the VA that does that work and I asked them why action had 

not been taken. And they told me they were, that they were looking 

for loss of bowel and bladder control. And I said that is not relevant, you do not need it. He already qualifies. And the lady was 

able to hear me out and I took her through the regulations and 


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statutes, which would take me a long time to go through, I wrote 

it up. And the veteran ended up getting the R2. It is on our website 

if you want to go look at the whole thing. We had a mix of the VA, 

like the band in Animal House that marched into the wall, it did 

not have loss of use, it only had loss of function. They were not 

going to accept those words. Kind of silly. 

But secondly the people that were doing the work did not know 

the law. The VA needs to do more to train people to understand 

SMC. The PVA, the DAV, the Legion, MOPH does a lot of work on 

that issue. And if you look in our textbook we have a formula that 

service offices in VA can use to properly evaluate. It is complicated 

and you have to look at it each time. Thank you. 

Mr. RUNYAN. Thank you. Mr. Gillums? 

Mr. GILLUMS. In order to effectively adjudicate an SMC claim 

you almost have to have an intuition for things that are pretty abstract. Like how do you measure need? In one case you will have 

a veteran with ALS. Because he or she has trace function in their 

legs, or can barely stand, the rater will find that the veteran has 

useful function of legs. And we argue it has to be useful in terms 

of daily living. And so a lot of it is over time it will be cultural. 

This culture, this new crop of raters are being trained to follow 

rules. 

I will give you an example. If a veteran presents with a letter 

from his clinician saying that he needs skilled care, that letter will 

trigger not some deliberation on the rater’s part. It triggers the 

need for a C&P exam. The C&P examiner will render an opinion 

as to whether the skilled care is needed or not. And depending on 

what the C&P examiner says will dictate whether the claim is accepted or denied. The problem is in the past if you were a trained 

rater and you understood SMC, you knew how to weigh evidence. 

You knew how to weigh two conflicting medical opinions and in 

that case it should be resolved in favor of the veteran. Well increasingly this contemplative aspect of rating SMC is being pushed out 

of the culture, being pushed out of the process. And so there is no 

contemplation of evidence. It is either there or it is not. This person 

can either walk because he has got three out of five function, or 

they cannot with no exploration of whether it is useful or whether 

the three out of five results in multiple falls because the veteran 

tries to stand but cannot and incurs subsequent injury. 

So a lot of it has to do with the fact that I believe the VA is going 

away from this inductive reasoning way of training its new people 

that probably made claims adjudication a bit longer, but it was 

more accurate if you got it right the first time. And so that is my 

insight. 

Mr. RUNYAN. Thank you. And I recognize Ms. Titus for her questions. 

Ms. TITUS. Thank you very much. I will ask Mr. Gillums and Mr. 

Hearn two questions. First, we have heard a lot about putting 

these complex cases in these lanes: easy, medium, and hard. I understand the value of that. But I wonder if that is really effective. 

Is that not oversimplifying? Would we be better off to nuance it a 

little more than that? Are we really creating a system that is going 

to produce more errors down the road and contribute to the appeals 

backlog? That is my first set of questions. 


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Second, I would go back to something I mentioned earlier: rate 

as you pay. We have talked about complex cases. Would it not help 

veterans that as you rate some of the easier aspects of these cases 

that have a number of different problems, that veterans get paid 

for those as you rate them instead of waiting until the end? 

Mr. GILLUMS. I think the lanes process has worked. The field 

staff that work for me like it. They like being able to go to somebody who is ostensibly a specialist in that type of claim, whether 

it is a Post Traumatic Stress Disorder, military sexual trauma, one 

of our severe disability cases. So it has worked. It really depends 

on the people, though. It really depends on how it is managed. And 

that can vary from regional office to regional office. Every regional 

office is not doing the wrong thing. A lot of them are doing the 

right thing. It is the ones that we hear about, though, where it 

does not matter what process they have in place. If the people are 

inadequately trained the greatest process in the world will not help 

them. 

To your question about the pay as you go, I think that for veterans who just need relief, they need some resources, it might be 

okay. My fear though is that when you pay a veteran, let us say 

a veteran gets that 100 percent rating, the mentality will be you 

have got your 100 percent rating, what more do you want? We have 

got you that, why are you coming back to us? Or that is going to 

be counted as a completed claim. I mean, how do you monitor completion of that claim? If, you know, the veteran is 100 percent and 

getting a check, there is still a lot of work that needs to be done 

in our cases. But you know, but we would have to make sure that 

there is no creeping standard where if they are getting paid that 

kind of sits on the back burner. 

Mr. HEARN. This past year when we were going out and doing 

those trips for the FDC and we visited, to include the one where 

we visited in Reno, we did discover that it did bring some order to 

the regional office by having those segmented lanes. One of the 

things, though, that when we went out there I would ask employees different questions. And one of the ones was how much experience do you have? And it was overwhelming, and I would talk to 

coaches and some more middle management and senior staff, and 

then talk about the relative greenness, I guess, of the staff at that 

regional office. 

Now I have heard senior leadership from VA say on repeated occasions that, well, the effects of the Nehmer case and the increase 

in claims due to Nehmer has affected the backlog. And then we 

have heard conversation about 9/11 and the increase in cases from 

there. But the one thing that no one seems to discuss is that you 

cannot beat back the hands of father time. And that we have now 

hit an era in this country where baby boomers are retiring in larger numbers. Now we did not go back and, they did not balloon the 

VA, I guess, at the time when they should have. And so now you 

have got this knowledge vacuum, I guess, in the regional office. So 

there just is not that much, there are not enough people, A, but B, 

there is not enough experience there. So it is, yes, it does help. But 

I think a lot of it, too, is that they just simply do not have that 

much experience within that regional office. 


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And then to go to the rate as you pay, I do think that it would 

be beneficial. If you think about the effects that you could if let us 

say somebody is trying to get service connected for three or four 

conditions, and you get them to the 50 or 60 percent, now they 

have got access to free healthcare through VA. In this age of ACA 

that is a very good avenue for them. 

I also think that in the cases of preference for federal employment when it comes to issues dealing with VA mortgages and not 

having to pay the funding fee, of course these are important. And 

also you are getting money into the veteran’s pocket. And so I do 

see the benefits. I agree, there probably are some concerns that we 

should look at as to how VA would monitor this and make sure 

that cases and claims are not just being set by the wayside while 

other things are occurring. But it is something worth considering, 

I think. 

Ms. TITUS. Thank you. 

Mr. ABRAMS. I would like to add something. 

Ms. TITUS. Thank you. Is that all right, Mr. Chairman? 

Mr. ABRAMS. It is the policy of the VA that when it has enough 

evidence to pay partially, it pays. The problem is that the workers 

do not get any work credit and therefore they are not encouraged 

to do it. 

Ms. TITUS. Right. 

Mr. ABRAMS. And we find many, many cases. So it is not a matter of VA policy which says when you have enough evidence and 

the veteran should be service connected, pay them at this level, 

and then when we get more we will, you know, up it. They do not 

want to take the time to do it because they are measured by how 

many cases they do, which gets back to my point of the work measurement system. And Sherman’s point that if you give somebody 

something maybe he will go away is the thought and we will not 

have to, or she, and there will not be any more to do. 

Ms. TITUS. Mm-hmm. 

Mr. ABRAMS. So they really want to get rid of the case at that 

point. Thank you. 

Ms. TITUS. Thank you. 

Mr. RUNYAN. I thank the gentle lady. Mr. Michaud? 

Mr. MICHAUD. Thank you very much, Mr. Chairman, and Madam 

Ranking Member for having this very important hearing. Information that the VA has provided us recently suggests that simply 

breaking out the work load into what they call those segmented 

lanes resulted in a ten percent processing increase during the first 

60 days. Also easy claims saw an increase in timeliness of 100 days 

faster than the special operation claims. However, we know that 

VA continues to do a poor job in handling some of our most challenging claims. As the VA OIG noted in their testimony, in their 

first round of inspections 31 percent of the TBI claims reviewed 

showed that staff had made errors. After informing staff of errors 

and VA taking action, the VA OIG returned to note that 29 percent 

of TBI claims reviewed were found to be in error. And you look at 

12 of the 20 offices reviewed were non-compliant with VBA’s own 

policies for two consecutive inspections. They also noted that even 

after extreme simplification of PTSD claims, five percent of these 

claims are still incorrect. 


VACREP180 with DISTILLER
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In my mind, you know, the facts speak for themselves, that we 

need to take the segmented lanes a step further by creating a few, 

you know, specific offices that specialize and focus on complex 

claims like TBI and PTSD and MST. These offices need specialists 

that are aligned in cross-functional teams but focused and trained 

in extremely complex cases. I believe that most of you at the table 

support H.R. 2088 that would create Centers for Adjudication Excellence. And my question, I will start with Mr. Gillums, in your 

testimony you articulate the problem with underqualified individuals handling complex claims. In your opinion would we be better 

off if we specialized in these complex medical conditions? And the 

other two panelists can answer that as well. 

Mr. GILLUMS. I do not remember how I characterized it but I 

think it is less about qualifications in some of the cases I have seen 

and more about the rules that constrain their ability to make judgments using the experience that they might have accumulated over 

the years. The rules are just different. So even in cases where you 

have got somebody who is qualified, the rules are different. The 

rules say you have to do these steps, you can no longer exercise 

common sense. If it says hospice, and common sense says that that 

is probably skilled care, you still have to ask for an exam otherwise 

the rating stands. That is a wrong rating. It is an inaccurate rating. And so that is where you get an error in that case. You do not 

exercise reasonable doubt. That is an error. You have to exercise 

reasonable doubt when the evidence is in equipoise. And they do 

not do that. So that is an error of law. So it really depends on a 

convergence of both an inexperienced corps of new raters as well 

as raters who have the knowledge and experience who do not have 

the freedom to exercise that judgment when it is necessary. 

And if you were, you know, sort of to compartmentalize that 

knowledge it really just depends on how you run it. If it is, if they 

are allowed to exercise that qualitative, deliberative thought process as they look at these claims in these compartmentalized Centers of Excellence, then it would work. But I do not think that is 

necessary. I think you could do the same thing with your special 

ops lanes but just give them the ability to think and make decisions, exercising good judgment, versus having rules dictated as a 

quality review standard. 

Mr. MICHAUD. Mr. Abrams? 

Mr. ABRAMS. Thank you. First of all, I think the essence of fairness is time. If we set up lanes and they are pressured to go real 

fast, it will not matter if they are the most knowledgeable people 

on the planet. They will make errors. Secondly, you are taking the 

veteran’s claim away from his local representative. The American 

Legion or other service organization representative in Boise, Idaho 

is not going to have access to the file or deal with the raters if the 

case goes to Denver. I am making that up, but that is a problem. 

In any case until you fix how they count their work, these are 

fixes that sound good on paper but are not going to make a major 

impact. That is the first thing to do. It sounds great but I also 

worry that if people are trained to deal in SMC, and that is all they 

do, then the rest of the VA raters are not going to know SMC. And 

unless they are trained they will only have a small component of 

people to do it. There is a lot of pros and cons to do it. 


VACREP180 with DISTILLER
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It is worth a try if we can also implement some way to give them 

the time to do it or to hire a lot more people to help. I keep saying 

that, a lot more people. Thank you. 

Mr. HEARN. Thank you. Generally speaking, like Ron has said, 

the American Legion favors the idea of local adjudication for 

claims. I think what you are saying, though, is that you are essentially going to create a workforce of warrant officers where they are 

specialized in particular areas. And this is the thing that I kind of 

question. If you are a high performing regional office, and you are 

assigned special monthly compensation, and then you are working 

in a different office and you are assigned something that is a little 

bit easier, say like tinnitus or something, what is that going to do 

to the morale for the people working in tinnitus? I mean, I would 

not feel too good for myself if they say well, this is all they think 

of me, I am stuck with the tinnitus game. 

And so I do not think that that is necessarily the way that you 

want to go about it. I think that you have to have a comprehensive 

approach to training and evaluation. I was speaking earlier in our 

office about it. I said if you, ten or 12 years ago when you passed 

No Child Left Behind the big concern in the education community 

was, well, teachers are going to start teaching to the test. And that 

is what some of these evaluations do. When they are looking at 

their star team reports it is a checklist. And Congresswoman Titus 

could attest to her years in academia, you do not want to test 

somebody’s knowledge on multiple choice exams. You want to test 

them on blue book exams. Because that is comprehensive understanding. And that is what our big concern is at The American Legion. Thank you. 

Mr. RUNYAN. Thank the gentleman. And I thank all of you today 

for your testimony and for the work you do on behalf of disabled 

veterans. You are now excused from the witness table and we will 

ask our third panel to come forward. 

This will be our final panel today. We welcome Mr. Tom Murphy, 

Director of Compensation Service with the Veterans Benefits Administration; also Ms. Edna MacDonald, who is Director of the 

Nashville Regional Office, accompanying Mr. Murphy today. We 

also welcome Sondra McCauley, Deputy Assistant Inspector General for Audits and Evaluations with the Office of the Inspector 

General, Department of Veterans Affairs. Ms. McCauley is accompanied by Mr. Brent Arronte, Director of San Diego Benefits Inspections Division. We appreciate your attendance today. Your 

complete and written statements will be entered into the hearing 

record. And Mr. Murphy, you are now recognized for five minutes. 

ORAL STATEMENT OF TOM MURPHY 

Mr. MURPHY. Chairman Runyan, Ranking Member Titus, and 

members of the subcommittee, thank you for providing me the opportunity to discuss the VA’s policies and procedures for adjudicating complex disability claims. I am accompanied today by Ms. 

Edna MacDonald, Director of the Nashville Regional Office. 

The VBA continues to experience an increase in the number and 

complexity of medical issues. Between 2011 and 2013 the average 

number of issues in original claims increased by 31 percent, from 


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5.5 to 7.2. In response VBA developed and implemented a new operating model. 

VBA has noticed an increase in complexity of the claims from the 

newer generations of veterans who participated in Operations Enduring Freedom, Iraqi Freedom, and New Dawn. These young heroes have a greater chance of surviving serious injuries and often 

return home with multiple serious conditions. In addition, VBA 

continues to receive complex claims from veterans of the Vietnam 

era. Many of these become complicated because they are subject to 

federal court orders in Nehmer v. U.S. Department of Veterans Affairs. 

The new organizational model incorporates cross-functional 

teams working on one of three segmented lanes, express, core, and 

special operations. Lanes were created based on complexity and 

priority of claims. 

The express lane develops and rates claims with a limited number of issues and subject matter which could be developed and 

rated more quickly. Core lane includes claims with three or more 

medical issues that do not involve special populations of veterans. 

The special operations lane applies intense focus and case management on specific categories of claims that require special processing 

or training. It is comprised of a regional office’s most highly skilled 

personnel with specialized experienced and training. 

VBA is simplifying ratings by building new decision support tools 

to make our employees more efficient and their decisions more consistent and accurate. One of them is the evaluation builder and it 

is essentially an interactive rating schedule. The rater uses a series 

of check boxes that are associated with the veteran’s symptoms. 

DBQs are another tool designed to simplify rating decisions. They 

replace traditional VA exam reports and capture all needed medical 

information up front and present the findings in a rater friendly 

format. 

Claims are considered complex for a variety of reasons. There are 

three examples. Due to the complexities of rating TBI the special 

operations lane processes these claims. Since March, 2013 all raters in this lane are required to complete specialized training. This 

web-based module is 22.5 hours on how to rate a claim for the residuals of TBI. Due to the myriad of symptoms that a veteran with 

TBI may experience, it is often unclear which symptoms are solely 

attributable to TBI. In October, 2011 Compensation Service provided guidance that examination findings should be related to the 

veteran’s TBI condition unless such symptoms are clearly attributable to other causes. In addition VBA has instituted safeguards 

to ensure consistency and accuracy. All raters are required to obtain a second signature on TBI claims until the individual demonstrates 90 percent accuracy in rating such claims. 

As a result of these efforts VBA has seen TBI grant rates increase from 21 percent in 2007 to 47 percent in 2013. Further, the 

accuracy of TBI ratings during fiscal year 2013 was 92.37 percent, 

slightly higher than the national average for all rating claims during the same period. 

Service connection for PTSD requires three things: medical evidence diagnosing the condition, an in service stressor, and a nexus 

connecting the two. In 2010 Secretary Shinseki made it easier for 


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veterans with fear based PTSD to establish service connection. VA 

added a regulation providing that a veteran’s lay statement alone 

can now establish the required in service stressor. VA provided extensive training on this regulation change to ensure consistent and 

accurate ratings. 

MST-based PTSD claims are processed by the special operations 

lane as well. Complications generally arise in situations where 

there is no corroborating evidence of the stressor in the veteran’s 

military records. In these cases VA must notify the veteran that 

the evidence from outside military records may be used to support 

and claim and must attempt to obtain any such evidence identified. 

In 2011 VBA conducted a quality review of 400 MST-based PTSD 

claims, which found that an approximate 25 percent error rate 

based primarily in incomplete development. We developed and implemented an MST-based PTSD training package that emphasized 

the proper evidence development and recognition of the types of 

evidence. Following the training the MST-based PTSD grant rate 

rose to a level comparable to that of other types of PTSD. 

VA has seen a significant increase in the complexity of claims received in recent years. To address this trend VA implemented a 

new organizational model with a special operations lane focusing 

on complex disability claims. 

This concludes my statement, Mr. Chairman. I would be happy 

to entertain any questions you or members of the subcommittee 

may have. 

PREPARED STATEMENT OF TOM MURPHY 

Chairman Runyan, Ranking Member Titus, and Subcommittee 

Members, thank you for providing me the opportunity to discuss 

Department of Veterans Affairs (VA) policies and procedures for 

adjudicating complex disability claims. 

I am accompanied by Ms. Edna MacDonald, Director of the 

Nashville Regional Office. 

The Veterans Benefits Administration (VBA) continues to experience an increase in the number and complexity of medical issues 

in disability claims received. Between 2011 and 2013, the average 

number of issues in original claims for service connected disability 

compensation increased by 31 percent, from 5.5 issues in 2011 to 

7.2 issues in 2013. In response to this trend and to achieve the Secretary’s goal of processing all claims within 125 days at 98 percent 

accuracy in 2015, VBA developed and implemented a new operating model that includes a formal mechanism to manage complex 

claims. My testimony will explain why certain claims are more 

complex than others and how VBA has improved our policies and 

procedures to provide more timely and accurate decisions to Veterans with complex claims. 

Backlog Update 

Before discussing the topic of today’s hearing, I would like to provide the Subcommittee with an update on our progress to date in 

eliminating the claims backlog. VA has significantlyreduced the 

backlog by approximately 


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34 percent, or approximately 210,000 claims since March 2013, 

and we expect the reductions to continue in upcoming months. Further, we continue to execute our claims Transformation Plan. 

More importantly, while increasing our productivity we have concurrently increased the quality of our work. In June 2011, our average for claims accuracy was approximately 83 percent; in August 

of 2013 that number was approximately 91 percent. When measuring accuracy at the medical issue level – which is a truer measure of VA’s workload – our rating accuracy today stands at 96.1 

percent. 

The current inventory of claims, backlog, and other workload 

measures for both the national level and at the regional office level 

are available by visiting http://www.vba.va.gov/reports/. The Monday Morning Reports provide workload indicators reported by VBA 

regional offices and are updated weekly. Similarly, the ASPIRE 

Dashboard provides monthly information on how VBA and regional 

offices are doing in relation to 2015 aspirational goals. 

None of this progress would be possible without the tremendous 

support VA receives from its partners including this Subcommittee, 

the rest of Congress, our Veterans Service Organizations, and 

County and State Departments of Veterans Affairs. Our progress 

is also the result of unprecedented effort and dedication of VBA 

employees, 52 percent of whom are Veterans themselves, and the 

support provided by our partners in VA’s Office of Information and 

Technology and Veterans Health Administration. Veterans themselves have contributed to our progress by participating in the 

Fully Developed Claims program and submitting claims electronically through the eBenefits Web site. We appreciate the support of 

all of our partners and stakeholders as we continue working to 

eliminate the claims backlog. 

Complexity of Claims 

From 2009 to 2013, the average number of issues included in a 

disability claim increased from 2.8 to 4.9. In particular, VBA has 

noticed an increase in complexity of the claims from the newer generation of Veterans who participated in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. These 

young heroes have a greater chance of surviving serious injuries 

and often return home with multiple amputations, blindness, 

burns, 

multi-organ system damage, and most notably, with the signature wounds of the war—traumatic brain injury (TBI) and 

posttraumatic stress disorder (PTSD). 

In addition, VBA continues to receive complex claims from Veterans of the Vietnam Era, who submit more claims than Veterans 

from any other period of service. Many claims from Vietnam Era 

Veterans are also complicated because they are subject to Federal 

court orders in Nehmer v. U.S. Dep’t of Veterans Affairs under 

which, when VA adds a new presumptive condition to the list of 

those conditions associated with exposure to herbicides used in 

Vietnam or modifies the definition of a presumptive condition, it 

must re adjudicate the claims of Veterans or eligible Survivors who 

previously filed claims seeking benefits based on that condition, 

and in appropriate cases, pay benefits retroactively to the date of 


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receipt of the denied claim. These court orders have added to the 

complexity of rating many claims from Vietnam Era Veterans. 

VBA Organizational Model 

In response to the increasing complexity of claims and to achieve 

the Secretary’s goal of processing all claims within 125 days at 98 

percent accuracy in 2015, VBA developed and implemented a new 

operating model by March 2013 that includes a formal mechanism 

to manage complex claims. Initially planned for deployment 

throughout fiscal year (FY) 2013, VBA accelerated implementation 

of its new organizational model by 9 months due to early indications of its positive impact on performance. 

The new organizational model incorporates a case-management 

approach to claims processing by reorganizing the workforce into 

cross-functional teams so that employees see the entire processing 

cycle of a Veteran’s claim. These cross-functional teams work together on one of three segmented lanes: express, special operations, 

or core. Lanes were created based on the complexity and priority 

of the claims, and employees are assigned to the lanes based on 

their experience and skill levels. An Intake Processing Center 

serves as a formalized triage process to quickly and accurately 

route Veterans’ claims to the right lane when first received. 

The express lane was developed to identify those claims with a 

limited number of medical conditions (i.e., about 1–2 issues) and 

subject matter which could be developed and rated more quickly. 

The special operations lane applies intense focus and case management on specific categories of claims that require special processing 

or training (e.g., homeless or terminally ill Veterans, military sexual trauma (MST), former Prisoners of War, seriously injured, etc.). 

These claims continue to receive priority processing. The core lane 

includes claims with three or more medical issues that do not involve special populations of Veterans. 

The special operations lane is comprised of a regional office’s 

most highly skilled personnel with specialized experience and 

training. The quality of our decisions improves by assigning more 

experienced and skilled employees to the more complex claims in 

our special operations lane. When VA receives a complex claim, a 

comprehensive screener ensures that the claim is correctly identified and routed to the appropriate member of the special operations 

lane. Because of the expertise of the screener, the claim is carefully 

examined to determine the next action required. For example, 

cases that are fully developed and ready for a decision will be routed directly to an experienced rater who will fully evaluate the 

claim. If the case requires additional evidence to support the claim, 

the screener will forward the case to an employee who will take the 

appropriate development action. The team includes a supervisor 

and claims assistants who perform important clerical work. The 

keys to success within the special operations lane are communication, attention to detail, and accountability. 

Calculators and Evaluation Builder 

VBA is also simplifying ratings by building new decision-support 

tools within the Veterans Benefits Management System (VBMS) to 

make our employees more efficient and their decisions more consistent and accurate. We have already developed rules-based calVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00061 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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culators for disability claims decision-makers to provide suggested 

evaluations. For example, the hearing loss calculator automates decisions using objective audiology data and rules-based functionality 

to provide the decision-maker with a suggested decision. 

The Evaluation Builder is essentially an interactive disability 

rating schedule. The VBA decision-maker uses a series of check 

boxes that are associated with the Veteran’s symptoms. Using the 

Evaluation Builder, the VBA employee determines the proper diagnostic code out of over 800 codes as well as the level of disability 

based on the Veteran’s symptoms. The Veteran receives an accurate rating decision every time the Evaluation Builder is used. This 

saves employees time that would have been spent looking up the 

rating schedule in a paper format. To date, 10 of the 15 body systems in VA’s Schedule of Rating Disabilities have been embedded 

into the Veterans Benefits Management System (VBMS). 

Disability Benefits Questionnaires (DBQ) 

DBQs are another transformation initiative designed to simplify 

rating decisions. DBQs replace traditional VA examination reports 

and are designed to capture all the needed medical information relevant to a specific condition at once and up front so that claims can 

be developed and processed in a more timely and accurate manner, 

with the end result being faster service for Veterans. DBQs change 

the way medical evidence is collected, often giving Veterans the option of having their private physicians complete a DBQ that provides the medical information needed to rate their claims – minimizing the need for a VA exam which adds additional time to the 

claim development process. 

Information in the DBQs maps to the VA Schedule for Rating 

Disabilities, and provides all of the necessary information to decide 

a disability claim. Fully and properly completed DBQs, whether 

from private providers or within the internal VA examination processes, have the potential to reduce rework, the largest category 

being exams with insufficient information. VBA’s future goal is to 

turn DBQ objective responses into data to drive a calculator-based 

business-rules engine in VBMS, to achieve automated decision 

support to improve consistency and accuracy of decisions, and reduce processing time per case. 

Examples of Complex Claims 

Claims are considered complex for a variety of reasons. Three examples are outlined below along with our efforts to provide more 

timely and accurate decisions for such claims. 

TBI 

Due to the complexities associated with rating TBI, the special 

operations lane processes claims from Veterans seeking compensation for TBI. Since March 2013, all raters in the special operations 

lane are required to complete specialized training on TBI. This 

Web-based TBI training module is a 22.5 hour course on how to 

rate a claim for the residuals of TBI. 

Veterans who file claims for TBI receive a compensation and pension examination, which is designed to elicit all clinical findings attributable to TBI. However, due to the myriad of symptoms that a 

Veteran with TBI may experience, it is often unclear which sympVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00062 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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toms are solely attributable to TBI. In October 2011, Compensation 

Service provided guidance that examination findings should be related to the Veteran’s TBI condition, unless such symptoms are 

clearly attributable to other causes. 

In addition, VBA has instituted safeguards to ensure consistent 

and accurate ratings for TBI claims. All raters are required to obtain a second signature on TBI claims until the individual demonstrates 90-percent accuracy in rating TBI claims. 

As a result of these efforts, VBA has seen TBI grant rates increase from 21 percent in 2007 to 47 percent in 2013. Further, the 

accuracy of TBI ratings during quality reviews during FY 2013 was 

92.37 percent, which was slightly higher than the national average 

for all rating claims during the same period. 

PTSD 

Service connection for PTSD requires: 1) medical evidence diagnosing the condition; 2) a link, established by medical evidence, between current symptoms and an in-service stressor; and 3) credible 

supporting evidence that the claimed in-service stressor occurred. 

VA recognizes that certain in-service stressful events may be difficult to document. 

In 2010, Secretary Shinseki took action to make it easier for Veterans with PTSD based on fear of hostile military or terrorist activity to establish service connection. Under the generally applicable 

criteria for PTSD, VA requires corroborating evidence of occurrence 

of an in-service stressful event from such sources as military personnel records, service treatment records, lay statements from fellow Servicemembers, or military unit records provided by the Department of Defense to service-connect a Veteran’s current PTSD 

symptoms. VA added a regulation providing that a Veterans’ lay 

statements alone can now establish the required in-service stressor 

if it is related to fear of hostile military or terrorist activity and a 

VA psychiatrist or psychologist or psychiatrist or psychologist with 

whom VA has contracted, confirms that the claimed stressor is adequate to support a PTSD diagnosis, and that the Veteran’s symptoms are related to the claimed stressor. VBA’s Compensation 

Service provided extensive training on this regulatory amendment 

to ensure consistent and accurate ratings were made after this 

change. As a result of this liberalized stressor-verification standard, outreach, and other factors, the number of Veterans in receipt 

of compensation for PTSD increased from approximately 374,000 in 

FY 2009, to 649,000 in FY 2013. 

PTSD Based on MST 

PTSD claims based on MST are one of the complex claims processed by our most experienced adjudicators in the special operations lane. Complications with these claims generally arise in situations where there is no corroborating evidence of the MST 

stressor in the Veteran’s military records. Delays can occur because 

VA must obtain the complete personnel file and seek evidence from 

sources other than the Veteran’s service records to corroborate the 

Veteran’s account of the stressor incident. Additionally, VA must 

notify the Veteran that evidence from outside military records may 

be used to support the claim and must follow up and attempt to 

obtain any such evidence identified by the Veteran. These developVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00063 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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ment issues add to the claims’ complexity, but VA has taken steps 

to address them. 

VA is committed to serving our Nation’s Veterans by accurately 

adjudicating claims based on MST in a thoughtful and caring manner, while fully recognizing the unique evidentiary considerations 

involved in such a claim. In 2011, VBA conducted a quality review 

of 400 MST-based PTSD claims, which found an approximate 25- 

percent error rate based primarily on incomplete development. To 

remedy this, we developed a MST-based PTSD training package 

and conducted a nationwide online training broadcast was conducted. The training emphasized proper evidence development and 

recognition of the types of evidence (such as erratic performance 

evaluations; sexually transmitted disease tests; requests for transfers; mental health counseling; behavior changes; and lay statements from fellow Servicemembers, family, or clergy) that can corroborate a Veteran’s account of the stressor incident. 

The training also emphasized that when there is corroborating 

evidence, including evidence of a behavioral change, VBA must request a disability compensation examination that includes a medical opinion about whether the evidence of record indicates that a 

personal assault occurred. This medical opinion can provide a basis 

upon which service connection for PTSD can be established. 

Following the training, the MST-based PTSD grant rate rose to 

a level comparable to the level for all types of PTSD claims. In 

order to assist Veterans’ whose claims were denied prior to the 

training initiative and who may benefit from additional evidence 

development for markers, we decided to conduct a review of previously denied MST-based PTSD claims, upon a Veteran’s request. 

VBA identified approximately 2,500 Veterans with previously denied MST-based PTSD claims and sent notice letters to the Veterans in April 2013. The letters invited the Veterans to request a 

review of the denied claims by their regional offices and to submit 

or identify any additional evidence to support their claims. Compensation Service updated the MST-based PTSD Training Letter to 

explain the review to regional office personnel. Additionally, VA’s 

National Call Center has developed and implemented a question 

and answer script on how to answer questions on the review process. 

There has been one additional legal development in the adjudication of MST claims. On September 30, 2013, the United States 

Court of Appeals for the Federal Circuit ruled in AZ v. Shinseki 

that, where an alleged sexual assault is not reported, the absence 

of service records documenting the alleged assault is not pertinent 

evidence that the assault did not occur. The court reasoned that because the majority of in-service sexual assaults are not reported 

and records of unreported sexual assaults do not exist, the absence 

of a service record in such a case is not reliable evidence and cannot be considered by VA. This legal development is consistent with 

VBA’s current policies and procedures as we do not make rating decisions based on the absence of a reported sexual assault in a service record. 

In FY 2013, the grant rate for MST-based PTSD was within six 

percentage points of the grant rates for all PTSD claims. The grant 

rate for male Veterans claiming MST-based PTSD is now within 


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seven percentage points of the grant rate for female Veterans 

claiming MST-based PTSD. In FY 2013, there was only a two percentage point difference in the grant rate for all PTSD claims submitted by male and female Veterans. 

Training and Accuracy 

VBA is committed to providing high quality, timely, and relevant 

training for both new and experienced personnel to ensure that 

claims-decision quality continues to improve. To this end, our 

transformation efforts include redesigned programs and tools that 

standardize training across our 56 regional offices. 

In 2012, VBA created Quality Review Teams (QRT) to improve 

employee training and decision accuracy while decreasing rework 

time. We reassigned 573 of our most skilled and experienced employees from their duties as claims processors to serve on QRTs. In 

FY 2013, these QRTs conducted more than 145,000 in-process reviews, preventing errors before they could impact Veterans and 

provided specialized retraining to claims processors so these errors 

can be prevented in the future. 

VA currently uses a 3-month rolling average to track the impact 

of initiatives on rating accuracy. These metrics are reported in ASPIRE and can be seen online by anyone inside or outside of VA. 

In FY 2012, VA showed a 

3-percent increase in national accuracy – from approximately 83 

percent to 

86 percent. In FY 2013, our 3-month accuracy at the claims level 

rose to approximately 90 percent, meeting the goal we set for ourselves this year. The accuracy outcome goals for the next 2 years 

are approximately 93 percent in 

FY 2014, and 98 percent in FY 2015. 

It is important to recognize that under the existing quality review system, any one error on the claim, no matter how many medical conditions must be developed and evaluated, makes the entire 

claim in error – the claim is therefore counted as either 100 percent accurate or 100 percent in error, with no credit for anything 

in between. Medical issues are defined as individually evaluated 

medical conditions. Given that the average number of medical 

issues in original claims filed by recently separated 

Servicemembers is now above 10 issues per claim, we do not believe the current all-or-nothing measure reflects the actual level of 

decision accuracy achieved. When we measure the quality of claims 

based on the individual medical issues rated (i.e., ‘‘issue-based accuracy’’), the accuracy of our decisions is at approximately 96.1 percent. This issue-based accuracy approach also affords VBA the opportunity to precisely target those medical issues where we make 

the most errors, at the individual employee level, and develop and 

direct training in a targeted manner. 

Conclusion 

VA has seen a significant increase in the complexity of claims received in recent years. To address this trend, VA has implemented 

a new organizational model with a special operations lane focusing 

on complex disability claims. We firmly believe this initiative, along 

with VBA’s other transformational initiatives, will help VA elimiVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00065 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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nate the claims backlog and achieve the Secretary’s goal of all 

claims completed in 125 days at 98 percent accuracy in 2015. 

This concludes my statement, Mr. Chairman. I would be happy 

to entertain any questions you or the other Members of the Subcommittee may have. 

Mr. RUNYAN. Thank you, Mr. Murphy. With that, I would recognize Ms. McCauley. 

ORAL STATEMENT OF SONDRA F. MCCAULEY 

Ms. MCCAULEY. Mr. Chairman and Members of the Subcommittee, thank you for the opportunity to discuss our work regarding complex disability claims processing issues. With me today 

is Mr. Brent Arronte, Director of our San Diego Benefits Inspection 

Division. 

In addition to our nationwide audits, the OIG reports on individual VARO effectiveness in providing timely and accurate benefits and services to veterans. Of major concern, however, is continued VARO non-compliance with VBA policy despite our recommendations for addressing issues we identify. 

Specifically in response to our May, 2011 report, VBA began requiring second-signature reviews of all TBI claims until raters 

demonstrate 90 percent accuracy in TBI claims processing. However, in fiscal year 2013 we saw only slight improvement since our 

first cycle of inspections. Twelve VAROs remained non-compliant in 

processing TBI claims for two consecutive inspections. Half of the 

errors were due to VARO staff using inadequate medical exams to 

rate TBI claims. 

In January 2011, we projected VBA incorrectly processed 15 percent of 100 percent disability evaluations for about 181,000 veterans, and paid a net $943 million without adequate supporting 

medical evidence. VBA implemented training and internal controls 

to address this issue. However, VBA repeatedly delayed completing 

its review of all 100 percent disability evaluations to ensure each 

had a future examination date entered in the electronic record. 

Our second cycle of VARO inspections continued to show a high 

error rate in processing these evaluations. In most cases errors occurred when staff did not enter suspense diaries in VBA’s electronic system to request medical reexaminations as required. 

We continue to review VBA’s systematic analyses of operations 

(SAOs), an organized means of reviewing Veterans Service Center 

(VSC) operations to identify problems and propose corrective actions. We found six VAROs remained non-compliant in this area for 

both cycles of our inspections. 

Generally VARO management did not provide adequate oversight 

to ensure SAOs were timely and/or complete. We noted a correlation between SAO non-compliance and VAROs having vacant or 

temporary director or VSC manager positions for five months or 

greater. 

Currently we are assessing VBA’s initiatives to improve claims 

processing and eliminate the backlog. We are reviewing the initiative VBA began on April 19, 2013 to process within 60 days all 

claims over two years old. Of note we determined ten of 11 provisional rating decisions at the Los Angeles VARO were non-compliVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00066 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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ant with VBA guidance. We found the VARO Director’s office had 

emailed conflicting guidance to staff requiring provisional rating 

without supporting medical evidence. Concerned that additional errors may exist, we recommended that VBA review for accuracy all 

470 provisional ratings completed by the Los Angeles VARO after 

the conflicting guidance was issued. 

Findings from our ongoing audit of the Veterans Benefits Management System (VBMS) suggest some progress. While VBA has 

reduced its inventory and average days to complete claims, we cannot determine if the improvements are related to VBMS or other 

transformation initiatives. Moreover, VBMS continues to experience performance issues and users rely on legacy systems to fully 

process claims. We have initiated a review to determine the extent 

to which VBMS helps VBA improve the accuracy and consistency 

of its claims rating decisions. We expect to report our findings in 

early 2014. 

In conclusion, VBA has made some progress but continues to face 

challenges to improving claims processing accuracy and timeliness. 

Inefficiencies mean not only added burdens and delays for veterans, but also improper payments that VBA will not likely recover. We will continue to look for ways to promote improvements 

in VBA benefits deliver during our future audits and inspections. 

Mr. Chairman, this concludes my statement. We would be 

pleased to answer any questions that you or other Members of the 

Subcommittee may have. 

PREPARED STATEMENT OF SONDRA F. MCCAULEY 

Mr. Chairman and Members of the Subcommittee, thank you for 

the opportunity to discuss issues related to the performance of Department of Veterans Affairs (VA) Regional Offices (VAROs) as 

identified in reports by the Office of Inspector General (OIG). The 

reports include audits of the programs and operations of the Veterans Benefits Administration (VBA) as well as inspections conducted at individual VAROs. I am accompanied by Mr. Brent 

Arronte, Director, OIG San Diego Benefits Inspection Division. 

Background 

Delivering timely and accurate benefits and services to the millions of veterans who provided military service to our Nation is 

central to VA’s mission. VBA is responsible for oversight of the nationwide network of regional offices that administer a range of veterans benefits programs, including compensation, pension, education, home loan guaranty, vocational rehabilitation and employment, and life insurance. These programs are estimated to pay out 

over $73 billion in claims to veterans and their beneficiaries in fiscal year (FY) 2014, and comprise approximately half of VA’s total 

budget. 

As part of our oversight responsibility, we conduct inspections of 

VAROs on a 3-year cycle to examine the accuracy of claims processing and the management of Veterans Service Center (VSC) operational activities. After completion of our inspections, we issue a 

separate report to each VARO Director on the inspection results. 

Our inspections address the processing of high-risk claims such as 

traumatic brain injury (TBI) and temporary 100 percent disability 


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ratings. We previously reviewed claims related to post-traumatic 

stress disorder (PTSD), however due to a change in regulations as 

well as improved accuracy in processing PTSD claims, we discontinued our reviews of these claims in FY 2012. 

In FY 2012, we completed our first cycle of reviews of all VAROs 

and began our second cycle of oversight. To date, we have completed 20 VAROs in our second cycle of reviews.1 We are also performing separate reviews focused on two of VBA’s major initiatives 

related to electronic processing of claims through the Veterans 

Benefits Management System (VBMS) and provisional decisions on 

claims over 2 years old. 

VA Regional Office Inspections 

Since FY 2009, we have conducted 77 VARO inspections and 

have consistently reported the need for enhanced policy guidance, 

oversight, workload management, training, and supervisory review 

to improve the timeliness and accuracy of disability claims processing and VARO operations.2 Of those offices that have been inspected twice, the Denver and Milwaukee VARO inspections had 

the highest (80 percent) level of overall compliance with VBA policy 

in the areas that we inspected.3 The Baltimore VARO had the lowest compliance rate in areas we inspected. . 

An area of concern from an oversight perspective is continued 

VARO non-compliance with VBA policy despite our initial identification and reports on such problems. In FY 2013, we inspected 20 

offices that we previously inspected and found 17 of the offices continued to be non-compliant with VBA policy in one or more of the 

protocol areas previously inspected. 

Disability Claims Processing 

In the second round of inspections, we are focusing on processing 

high-risk claims, TBI claims and temporary 100 percent evaluations. We adjust our inspection protocols as needed, with some review areas continuing year-to-year while others are replaced because VAROs have demonstrated improvements in performance of 

those review areas or in some cases, changes in VBA policy.4 

Traumatic Brain Injury Claims 

In response to a recommendation in our May 2011 report, Systemic Issues Reported During Inspections at VA Regional Offices, 

VBA agreed to develop and implement a strategy for ensuring the 

accuracy of TBI claims decisions. The then-Acting Under Secretary 

for Benefits responded by providing guidance to VARO Directors to 

implement a policy requiring a second signature on each TBI case 

that a Rating Veterans Service Representative (RVSR) evaluates 

until the RVSR demonstrates 90 percent accuracy in TBI claims 

processing. The policy indicates second-signature reviewers come 

from the same pool of staff as those used to conduct local station 

quality reviews. Yet, we continue to identify significant processing 

errors related to TBI disability claims in our most recent inspections, and in many cases, the errors occur despite secondary reviews. 

Our 77 inspections to date showed that staff had made errors in 

31 percent of the TBI claims we reviewed. More than half of the 

errors we identified were due to VARO staff using inadequate medVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00068 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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ical examination reports to evaluate residual disabilities associated 

with traumatic brain injuries. We learned through interviews that 

RVSRs were not consistently returning the inadequate reports to 

VA medical facilities as required due to pressure to meet production requirements. A common scenario in TBI claims processing involved veterans who had TBI-residual disabilities as well as co-existing mental conditions. When medical professionals did not ascribe the veterans’ overlapping symptoms to one condition or another condition as required, VARO staff could not make accurate 

disability determinations. RVSRs’ difficulty in following complex 

TBI claims evaluation policies is contributing to the TBI claims 

processing errors. 

In the first inspection cycle, we reviewed 1,077 traumatic brain 

injury claims at 57 offices and found 338 (31 percent) of these contained processing errors. In FY 2013, during subsequent inspections at 20 offices, we examined 411 claims and found 118 (29 percent) of these cases had errors—demonstrating some improvement 

in the error rate percentages. Twelve of the offices inspected were 

non-compliant with VBA policy for two consecutive inspections.5 In 

most cases, the errors occurred because VARO staff used inadequate medical examination reports to evaluate residual disabilities associated with traumatic brain injuries. 

Temporary 100 Percent Disability Evaluations 

In our January 2011 audit report, we projected VBA had not correctly processed 100 percent evaluations for about 27,500 (15 percent) of 181,000 veterans.6 We reported that since January 1993, 

VBA had paid veterans a net $943 million without adequate medical evidence to support the payments. We concluded that if VBA 

did not take timely corrective action, it could overpay veterans a 

projected $1.1 billion over the next 5 years. The Under Secretary 

for Benefits agreed with our seven report recommendations for implementing training and internal control mechanisms to improve 

timeliness in processing these types of claims. To date, VBA has 

implemented six of the seven recommendations. 

However, of major concern is VBA’s delay in implementing the 

final recommendation, to review all temporary 100 percent disability evaluations and ensure each had a future examination date 

entered in the electronic record... The Acting Under Secretary stated the target completion date for VBA’s national review would be 

September 30, 2011. However, VBA did not provide each VARO 

with a list of 100 percent disability evaluations for review until 

September 2011. VBA subsequently extended the national review 

deadline on four occasions. To date, VBA has not completed this 

national review requirement and improper monthly benefits continue to be paid despite a lack of adequate medical evidence. 

Although VBA has requested we close the final recommendation 

on several occasions, we have not been able to substantiate that 

VBA’s methodology for identifying all claims that may be paying 

inaccurate benefits is effective. Further, VBA’s methodology does 

not call into question a veteran’s 100 percent disability evaluation 

if there is also an associated control referred to as an ‘‘end product’’ 

to alert VBA claims processing staff of the need to review the claim 

at a later date. Having a control in place is not providing adequate 


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assurance that the reviews will occur or that reviews will be timely. VBA designated the use of end product 684s as the control to 

ensure staff review 100 percent disability evaluations to determine 

if the monthly payments are accurate. However, VBA does not 

have performance metrics in place for end product 684s establishing a timeframe in which staff are expected to review and take 

corrective actions on pending end product 684s. As of November 19, 

2013, VBA had 7,562 end product 684s pending on average for 340 

days showing delayed corrective actions to identify and discontinue 

potential improper payments. 

We continue to follow up on these audit results during our VARO 

inspections and continue to find significant processing errors. Inspection results from 71 benefits inspections show VARO staff incorrectly processed 61 percent of the temporary 100 percent disability evaluations we reviewed, resulting in over $19 million in 

overpayments to veterans. The majority of these errors occurred 

when VARO staff did not input reminder notifications in VBA’s 

electronic system to request reexaminations of these veterans as required by VBA policy. 

For the first inspection cycle, we reviewed 1,480 temporary 100 

percent disability evaluations at 51 offices and found 973 (66 percent) of these contained processing errors. In FY 2013, during subsequent inspections, we examined 594 claims and found 290 (49 

percent) of these cases had errors. Twelve of the offices inspected 

during FY 2013 were non-compliant with VBA policy for two consecutive inspections.7 In most cases and for both inspection cycles, 

the errors occurred because staff did not enter reminder notifications in VBA’s electronic system to request re-examinations for veterans with temporary disability evaluations as required. We did 

identify improvement in this area in our 2013 inspections; however, 

in our view the error rates continue to be significant. 

Post-Traumatic Stress Disorder 

When we began our VARO inspections, we included PTSD claims 

processing as a review area. In our summary report dated May 

2011, we projected VARO staff did not correctly process 1,350 (8 

percent) of approximately 16,000 PTSD claims completed from 

April 2009 through July 2010. About 38 percent of the errors were 

due to staff improperly verifying veterans’ alleged stressful events, 

a requirement for granting service connection for PTSD. VARO 

staff lacked sufficient experience and training to process these 

claims accurately. Additionally, some VAROs were not conducting 

monthly quality assurance reviews. For these reasons, veterans did 

not always receive accurate benefits. 

Effective July 13, 2010, VA amended its rule for processing 

PTSD disability compensation claims. The new rule allows VARO 

staff to rely on a veteran’s testimony alone to establish a stressor 

related to fear of hostile military or terrorist activity, as long as the 

claimed stressor is consistent with the circumstances of service. 

This change significantly reduced processing errors associated with 

PTSD claims. Prior to the rule change, we identified a 13 percent 

error rate in PTSD claims processing; after the rule change the 

error rated dropped to 5 percent. As such, we no longer review 

these types of claims. 


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Operational Issues 

One area that we continue to review is VBA’s Systemic Analysis 

of Operations (SAOs). An SAO is an organized means of reviewing 

VSC operations to identify existing or potential problems and propose corrective actions. During the first inspection cycle, we identified 30 of the 56 offices inspected were non-compliant with VBA 

policy. In FY 2013, during subsequent inspections at 20 offices, 9 

of the offices inspected were non-compliant—of these 6 were noncompliant for two consecutive inspections.8 Generally, SAOs were 

untimely and/or incomplete because VARO management did not 

have adequate oversight to ensure SAOs addressed all necessary 

elements and operations of the VSC and that they were submitted 

by the required due date. 

Another area of concern is VBA management vacancies. We 

noted a correlation between VAROs producing complete and timely 

SAOs and VSC compliance with other VBA policies. We found that 

five VAROs, where managers ensured SAOs were timely and complete, were the most compliant in other operational activities we inspected. Conversely, of the six VAROs that had untimely and/or incomplete SAOs, five had the lowest performance in other operational activities, such as claims processing, mail handling, and 

data integrity. At five of the six least compliant VAROs, vacancies 

in senior management positions contributed to delays in completing 

SAOs and implementing corrective actions. These VAROs had Director or Veteran Service Center Manager positions vacant or filled 

with temporary staff for periods of 5 months or greater. For example, during the 8-month absence of the Anchorage Veterans Service 

Center Manager, that office did not have any senior leadership 

physically in place to manage and oversee operations. 

Current OIG Work On VBA Initiatives 

We are assessing VBA transformation initiatives to improve 

claims processing and eliminate the backlog. Specifically, we are 

conducting reviews of two key VBA initiatives: processing of claims 

over 2 years old and implementation and accuracy of the Veterans 

Benefits Management System (VBMS)—VBA’s web-based, 

paperless claims processing solution to support improved business 

processes. 

Claims Processing Initiative: Rating Claims Pending Over 2– 

Years 

On April 19, 2013, VBA implemented a special initiative to address the oldest pending disability claims in the current backlog. 

VBA stated the intent of the initiative was to work all claims pending for more than 2 years within 60 days, beginning April 19, 2013. 

VAROs were directed to devote all RVSRs and as many Veterans 

Service Representatives as needed to ensure all claims pending 

over 2-year old were processed and completed. According to VBA, 

RVSRs were to immediately process the 2-year old claims based on 

the available evidence in the veterans’ claims folders. Further, rating decisions produced were to be considered provisional ratings 

unless all evidence in support of the claims had already been received (and the claim was considered ready-to-rate) or the ratings 

assigned provided the highest evaluation for the particular diagnostic code for each claimed issue. However, if medical examination 


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reports or other Federal records were needed, these older claims 

could not be processed as provisional rating decisions. 

During one review errors were identified at the Los Angeles 

VARO when leadership provided conflicting guidance on the proper 

procedures for processing provisional rating decisions. We determined 10 (91 percent) of 11 provisional rating decisions we reviewed were not compliant with VBA’s guidance related to the 2- 

year claims processing initiative. Eight of the 10 provisional decisions were determined to be non-compliant because the rating decisions were made without supporting VA medical examinations as 

required. One claim was decided without Service Treatment 

Records, which are considered Federal records and must be obtained by VARO staff prior to rendering a provisional rating decision. In the remaining case, the provisional rating was controlled 

by a future diary that scheduled the claim for review in 2 years instead of 1 year as required. 

Requiring a rating decision to be rendered before a medical examination is obtained as a basis for a decision is in conflict with 

VBA policy. On May 14, 2013, conflicting guidance was sent to the 

Los Angeles VARO staff via an e-mail from the VARO Director’s 

office. The guidance incorrectly stated all 2-year old cases requiring 

a medical examination must have the medical examinations ordered by May 15, 2013. This conflicts with VBA guidance because 

if a medical examination was required to decide a claim, the claim 

could not be completed as a provisional decision until staff obtained 

the necessary medical examinations. The guidance also incorrectly 

indicated that any claims with medical examinations not completed 

by June 3, 2013, were to be decided by a provisional rating. 

We are concerned similar errors may exist among other provisional rating decisions completed by the Los Angeles VARO after 

the conflicting guidance was issued. VBA provided data that revealed the Los Angeles VARO completed 532 provisional rating decisions between April 19–June 19, 2013. VARO staff completed 470 

of those 532 provisional decisions claims after the conflicting guidance was disseminated on May 14, 2013. All 10 provisional rating 

decisions that we identified as non-compliant were completed after 

this date. We recommended that VBA review all of the provisional 

rating decisions completed by the Los Angeles VARO after the conflicting guidance was issued to ensure they are accurate. 

Veterans Benefits Management System (VBMS) 

VBA and VA’s Office of Information and Technology (OI&T) are 

jointly developing VBMS, which is a web-based paperless claims 

processing system. As one of VBA’s main transformational initiatives, VBMS is designed to assist VA in eliminating the claims 

backlog and serve as the enabling technology for quicker, more accurate, and integrated claims processing in the future. 

Over the past several years, the OIG has repeatedly reported deficiencies concerning the development, testing, and deployment of 

major systems throughout the department. In February 2013, we 

reported that because of system complexities and the incremental 

software development approach VA chose, VBMS had not been 

fully developed to the extent that its capability to process claims 

from initial application through review, rating, and award, to beneVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00072 Fmt 6633 Sfmt 6633 Y:\85872.TXT PAT

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fits delivery could be sufficiently evaluated.9 Thus we concluded 

that, as of September 2012, VA had not fully tested VBMS. 

In February 2013, the OIG launched a follow-up audit of VBMS 

to determine whether VA is effectively managing VBMS development and whether the project is positioned to meet schedule, costs, 

and performance goals. We expect to complete our audit in March 

2014. Currently, VBMS has one pilot site that provides the capability to process claims from initial application through review, rating, award, to benefits delivery. VBMS also continues to suffer 

from system performance issues forcing users to rely on legacy systems to process claims. 

In June 2013, VBA completed its implementation strategy to install VBMS at all VAROs. After the rollout of VBMS, VBA’s inventory of pending claims was just under 797,000 and took an average 

of 238 days to complete. By the end of FY 2013, VBA had reduced 

its inventory of pending claims by 10 percent and reduced the average days to complete by 58 days. We cannot determine if the reduction in the pending inventory or the improvement in claims processing timeliness is related to VBMS or to one of VBA’s many improvement initiatives. 

In our recent inspections of the Houston, Newark, and Milwaukee VAROs, 25 staff provided us a user perspective of VBMS. 

Generally, staff expressed frustration with the system in part because of spontaneous system shut-downs, latency issues related to 

slow times to download documents such as medical evidence for review, longer times to review electronic evidence, mislabeled electronic evidence, and mixing evidence from one veteran’s electronic 

file with another veteran’s. 

Given concerns raised at VAROs and complaints received 

through the OIG Hotline, we initiated a review of the accuracy of 

rating decisions completed using VBMS. We want to determine if 

the automation initiative will be effective in assisting VBA in meeting its goal of eliminating the disability claims backlog and improving the accuracy and consistency of rating decisions. We expect to 

report on our findings in early 2014. 

Conclusion 

VBA continues to face challenges in improving the accuracy and 

timeliness of disability claims decisions and maintaining efficient 

VARO operations. Our inspections and audit work consistently has 

shown that VAROs do not always comply with VBA’s national policy to accomplish their benefits delivery mission. Claims processing 

and operational problems result in not only added burdens and delayed or incorrect payments to veterans, they also mean wasted 

Government funds through improper payments that VBA will not 

likely recover. While VBA made some incremental progress 

through its own initiatives and in response to our prior report recommendations, more work remains to be done. We will continue to 

look for ways to promote improvements in benefits delivery operations during our future nationwide audits and VARO inspections. 

Mr. Chairman, this concludes my statement. We would be 

pleased to answer any questions that you or other Members of the 

Committee may have. 


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Mr. RUNYAN. Thank you, Ms. McCauley. And I will begin a round 

of questions with myself. And the first question probably for Mr. 

Murphy, and Ms. McCauley I will have you both kind of touch on 

it. And it precisely touches on one word here: accuracy. Mr. Murphy, VA uses the term accuracy frequently. Today we have heard 

from veterans, representatives of veterans, VSOs, and VA Office of 

the Inspector General, who indicated that claims are not being correctly decided at a very high incidence. The files lack proper development and the medical examinations are not adequate. VA OIG 

added that our VSRs are not consistently returning adequate medical reports to VA facilities as required due to pressure to meet production requirements. 

In a moment I would like you to explain in detail how VA calculates and represents a 91 claims-based accuracy. I find VA’s representations of accuracy to be even more concerning when you state 

that VA’s TBI accuracy to be over 92 percent. VA OIG, who is specifically tasked to perform quality reviews of TBI claims, reports 

that over 30 percent of cases nationally, employees are not compliant with VBA policy, with individual ROs showing error rates as 

high as 50 percent. 

So here is the question. Does accurate by VA standards mean 

that the veteran received the correct rating decision for the claimed 

conditions upon full and proper development of the claim? And if 

accurate indicates anything less than this, what does it mean? 

Mr. MURPHY. Accuracy means exactly what you said, Mr. Chairman. Did the veteran receive the proper benefit entitlement payment or decision in the case of a denial? That is the measure of 

accuracy conducted by our quality analysis staff in Nashville and 

reported out. That is what the 91 percent means. That number is 

drawn from a true statistically valid nationwide sample, random 

sample, applied to all regional offices, collected into Nashville each 

month, evaluated, returned to the regional office, and then summed 

up on a rolling 12-month average. 

Mr. RUNYAN. Why do we have a discrepancy with the OIG numbers then? 

Mr. MURPHY. The IG and VBA do not measure what an error is 

exactly the same way. I look at an error as did the benefit entitlement be wrong, number one? And the IG tends to look at it from 

the standpoint of did you follow the process? If you varied from the 

process but you got the benefit entitlement decision right, I will not 

call that one an error. However, the IG will. 

But there is something more important that you need to hear 

and it is a quote from the IG report which says, ‘‘We sample claims 

we consider at higher risk of processing errors. Thus these results 

do not represent the overall accuracy of disability claims processing 

at this VA regional office.’’ This is the page from the title of the 

IG report. There is one of these in each report. 

My point is this: the IG by design targets a specific subset of 

known high errors. If you take that number and extrapolate it out 

to, say, the entire regional offices this way, it is not an accurate 

representation of the sum of work for that regional office. I am not 

disputing that is an accurate representation for the subset that 

they looked at. But not for the totality of work that comes out of 

the regional office. 


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Mr. RUNYAN. No, but I am having the discussion, but we also 

broke it down to just TBI cases and your numbers conflict there. 

Mr. MURPHY. Yes, our numbers conflict there. The IG’s reports 

that you are looking at here are a sum of several years worth of 

work. The numbers I am giving you are a sum of the last 90 days 

worth of work. My point is this. When you look at current, where 

we were and where we are, the IG report is much more reflective 

of where we were, not necessarily where we are sitting right now 

today. 

Mr. RUNYAN. Ms. McCauley, can you respond to that? 

Ms. MCCAULEY. Yes. The numbers for TBI that we reported they 

are 31 percent error rate, that was based on our first round of inspections from 2009 to 2012. More recently we found a 29 percent 

error rate and that was for our fiscal year 2013 inspections. As Mr. 

Murphy, suggested we do look at specific high-risk type of claims. 

And so we are not looking across all the different kinds of claims 

to come up with an accuracy rate, but rather to focus in on those 

such as TBI or temporary 100 percent disability evaluations that 

have shown repeatedly to have a high error rate. 

Also, there is a big difference in terms of how we call errors and 

how VBA calls errors. We do not focus just on the benefits entitlements amounts. When we look at the claims, we look at the processing of the claim, human error, system error, processing error, 

did they follow regulations—all of that goes into the accuracy of a 

claim. Sometimes the benefits entitlement might be correct for the 

moment, but sometimes there are errors that are made that could 

have potential impact on benefits down the road, future benefits for 

the veteran. So we look at the totality of the claims processing exercise. 

Mr. RUNYAN. One more question. Talking about how you compile 

statistics, does the VA keep track of accuracy an appeal rate by the 

number of years of experience by the RVSR or the DRO? 

Mr. MURPHY. Accurate from the standpoint of I can go back to 

my office and give you a report that says this, no I do not report 

it out that way on a routine basis. However, in determining the 

training that we are doing, the types of training that we are doing, 

where we are spending our effort, where the errors, the high concentration of errors are, I use that data every single day to determine exactly what training I need to be doing, where I need to be 

concentrating it, even down to the regional office level. And by 

tracking and looking at errors at an issued based level, which we 

started doing more than a year ago at this point, I now have the 

ability to go in and say TBI is a high error rate in a particular regional office and target just the raters that work TBI, as an example. 

So to give you back to the office and give you a report and say 

here it is, no, I do not track it that way. However, in all of our 

training process and everything else that we do, that information 

is considered on a regular basis. 

Mr. RUNYAN. But what I, where my head is on this is is it because of a lack of experience at some level? It came up in the last 

panel, that maybe we do not even have enough people with the experience to be able to rate these things. Is that trackable in your 

statistics? 


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Mr. MURPHY. Let me go back to your first question, Mr. Chairman. This is an excerpt from the Waco report. It talks about traumatic brain injury, reviewed 30 cases. Cases in error that affect 

veterans’ benefits: zero. Potential to affect veterans’ benefits, the 

difference of rules between how the IG looks at it and how I look 

at it, is eight out of 30. There is the 30 percent error rate that you 

are talking about. Did the veteran receive the right check based on 

what they had? Yes. Was there maybe a process that was done different but they got the right benefit entitlement check? Yes. An 

error in the IG’s eyes, but when you look at that from the veteran 

focus that was the right decision and the right compensation was 

received by that veteran. 

Mr. RUNYAN. We always have, what I am just trying to ask is 

it possible to find the analysis of does someone that has more experience in, say a certain regional office has more experienced personnel in it, are you getting a better outcome there? 

Mr. MURPHY. Are we getting a better output in the—— 

Mr. RUNYAN. With experience—— 

Mr. MURPHY. Yes. 

Mr. RUNYAN. —of the claim adjudicator? 

Mr. MURPHY. Yes, you are. No question. 

Mr. RUNYAN. You track that? 

Mr. MURPHY. We track that. In fact, we did a what we call a consistency study the first week of August. And we broke it down with 

six questions that were sent out to all people. This one happened 

to be on, I think it was diabetes, yes. And what we did is we broke 

it down by lanes, we broke it down for the quality review teams 

for the STARS staff, and I laid all of the different segmented populations of work lanes. And by a long shot, meaning in the mid to 

high 90 percent range, the special operations lane got those questions right at a much higher percentage, at the 93 or 94 percent 

rate, where the average for the total population was in the mideighties. The point being that the higher experience level, the better education, the more training that we are doing with those individuals, is yielding better results, more consistent results of higher 

quality. At the same time we are concentrating those more trained, 

more experienced people on the most complex conditions that we 

are dealing with. 

Mr. RUNYAN. If at all possible I would like to have staff be able 

to reach out to you and maybe take a look at those numbers? 

Mr. MURPHY. Yes, sir. I would be happy to provide that. 

Mr. RUNYAN. I appreciate that. And I recognize the Ranking 

Member Ms. Titus. 

Ms. TITUS. Thank you, Mr. Chairman. I would like to look at 

those numbers, too, if we can get them back, try to get some sense 

of or some order to them. 

Mr. Murphy, I have been talking about pay as you rate a good 

bit today because I think it fits in with this notion of the three different lanes and how to deal with complex cases. And we know 

that the VA has the authority to do pay as you rate. And I wonder 

if you would talk about that? Talk about what the problems are, 

of why you do not use it more often. And is the problem of how VA 

compensates the people who make these decisions based on a full 


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claim decided, or a part claim, something we can address? That is, 

the concerns that were brought up in the previous panel about it. 

Mr. MURPHY. The previous panel brought up comments about 

you did not get work credit for it so it was not work. 

Ms. TITUS. Right. 

Mr. MURPHY. Without going down and saying yes, that is right, 

no that is not right, let us take that as a base to talk about what 

we are putting in place actively right now. Which is exactly what 

you are describing. I receive a claim from a veteran that has got 

ten issues on it. I need to break that down into ten issues, and 

have maybe one rater rate ten, maybe have ten raters rate one 

each. But the point is this. Break it down into ten individual 

issues. Make rating decisions on those ten individual issues. And 

compensate the veteran if they are entitled to it as those rating decisions become, as they are made. And we move forward to do the 

other. 

The problem with that is in the system we are working with 

right now today, that is very difficult to do. And there are some 

barriers in terms of it is much less efficient in the amount of time 

that it takes our overall process to rate ten individual issues at one 

each. The fixes that we are putting in place will allow that to go 

significantly faster. And then our intent is to do exactly that, which 

is rate by issue. 

And so we understand what is in your bill. We have testified on 

that previously, that we agreed with that bill in concept. But at 

this point in time there were some complications due to our system 

limitations. 

Ms. TITUS. Well when do you anticipate that those changes will 

be made? 

Mr. MURPHY. I cannot put an exact date on it for you. But what 

I can tell you is every 90 days we do a new release at VBMS and 

I am not sure which one of those releases that some of these 

changes are in. One of the changes that is going in that is being 

piloted right now in one regional office is the VBMSA, or authorization module. And we need that in place in order to help these individual issues as they are decided to move through the system 

quicker. In other words, when I have the VBMS authorization module in place I will be able to process these individual issues without 

impacting the total system time. 

Ms. TITUS. And will there be safeguards in place so that you do 

not just pay a veteran off for a few things and think he will go 

away, as opposed to really completing the entire claim? 

Mr. MURPHY. Yes. We are looking at breaking this down so that 

it comes in as a single claim but it is posed in our system and we 

track it as though there are ten individual claims. So this is not 

just a, I am going to receive a claim and then I am going to break 

it up and process by issues. This is a true issue-based tracking, 

issue-based reporting, issued-based quality, everything. 

Ms. TITUS. I know that some of the cases that are in the Reno 

office have been farmed out to other offices where they can be 

moved faster. If you start breaking a claim down so that some of 

the things are easy and some are more complex end up in different 

lanes, you are not going to end up in two different places, are you 

for your claim to be completely considered? 


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Mr. MURPHY. Well depending on Mr. Michaud’s question just a 

little while ago about Centers of Excellence, we certainly need to 

consider whether those two issues that are in two different lanes 

even need to be in the same regional office. Why if we go with the 

concept of Centers of Excellence, and Detroit happens to be on 

issue number one and St. Petersburg issue number two, why would 

we not send that claim? Because it is seamless now once I have it 

in the electronic environment. I can move them around the country 

by just a few keystrokes. So we still do not have the final this is 

exactly how it is going to be, but we are exploring the options from 

how do I get it through our system right and fast? 

Ms. TITUS. We just don’t want to make it more difficult for our 

veterans to be able to track where their claim is or understand 

what’s happening with it and when it’s happening without scattering it around or making it more complicated. 

Mr. MURPHY. Yes. And you’re seeing that. You are—one of the 

information points I’m sure you’re interested in is the number of 

cases you currently have broken up from the regional office. It’s 

under —— 

Ms. TITUS. That’s right. And we’re waiting for some of those answers. 

Mr. MURPHY. It’s just under 700 right now. And it’s—you’ve 

heard what we are doing with the two-year-old claim and the oneyear-old claim and now moving to the 334 days. If the capacity of 

the regional office isn’t in place in order to meet the time lines that 

we’re putting in to meet these different deliverables on the oldest 

claims, we’re shipping them off to other regional offices. 

In other words, we’re making the oldest claim issue a national 

problem, and not one tied to a particular regional office. It just so 

happens that in Reno today, they happen to have a large number 

of the older claims, so we’ve sent those to other regional offices that 

have capacity to get those veterans done in a timely manner. 

Ms. TITUS. Thank you. 

Mr. RUNYAN. Thank you, gentle lady. And I’ll recognize Mr. 

Michaud. 

Mr. MICHAUD. Thank you, Mr. Chairman, and I want to thank 

this panel as well for your testimony today. Mr. Murphy, VBA currently adjudicates claims related to Camp Lejeune in Louisville, 

Kentucky, and claims related to radiation in Mobile, Alabama. Can 

you explain to the Committee why this is? 

Mr. MURPHY. Well, those claims actually fall under the title of 

this hearing. They are complex claims. They are highly complex 

claims. And what we don’t want to do is we don’t want to have a 

veteran, because they went to Regional Office 1, get one decision— 

an equivalent case go to Regional Office 2 and get a different rating 

decision. 

So in order to do that, in order to concentrate our efforts and because of the way we were doing claims in the paper world, we concentrated them in single places. We provided special training for 

the processors and raters that worked the claims, and then at the 

same time, we went back and worked with VHA and provided 

training to the individual C&P examiners that would be working 

these particular types of conditions and then sent that back to a 


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single, jointly trained rating board so we get a consistent, accurate 

output. 

So those two areas are specialized in those particular —— 

Mr. MICHAUD. Absolutely. Okay. For the OIG, Ms. McCauley, 

throughout your inspections on these difficult medical conditions, 

how often is training and a lack of knowledge regarding policies 

and procedures is a problem? How often is that? 

Ms. MCCAULEY. It certainly has shown itself to be a problem as 

a result of our inspections. For example, in TBI, it’s been said repeatedly today about the complexity of the policies for rating TBI 

claims. We did find that additional training was needed in the TBI 

area for the raters to be able to rate claims correctly, especially 

with regard to the issue of inadequate medical examinations—making sure they return them to the medical practitioners so that they 

get the adequate information they need to rate those claims. 

Mr. MICHAUD. Okay. In consideration of your response, do you 

think a veteran would benefit from having teams where specialty— 

that are specially trained and focused on complex conditions such 

as TBI, MST, and PTSD, similar to what we just heard Mr. Murphy mention about Camp Lejeune and radiation in Mobile, Alabama? 

Ms. MCCAULEY. Well, we haven’t examined the issue of the specialized claims, but certainly additional training would be a help in 

terms of adjudicating those claims. 

Mr. MICHAUD. So the better trained, the better specialized the 

workers are in the work that you have done, the more accurate 

they can and timeliness that they can process those particular 

claims? 

Ms. MCCAULEY. We would expect that, yes. 

Mr. MICHAUD. All right. Thank you. Mr. Murphy, just to followup on my previous questions about Camp Lejeune and Mobile, Alabama where you specialize in those particular areas, one of the 

problems I’ve seen over time being on this Committee is—and particularly in some regional offices where the error rate is over, as 

you heard the Chairman, over 50 percent. When you look at the 

turnover rate in those areas, they might not be an employer of 

choice, and you’re constantly training individuals, and particularly 

with our veterans coming back from Iraq and Afghanistan with 

TBI and PTSD and MST issues, I think it’s important that with 

the new VBMS system, I like the idea when you’re looking at the 

medical conditions, because with the medical conditions you can 

move that anywhere around the country in a timely fashion. So if 

there is a certain regional office that is specialized, such as Camp 

Lejeune in Louisville, Kentucky, to deal with those issues, that 

they can get an accurate decision in a timely manner. 

I understand some of the concerns that some of the VSOs might 

have that it’s all not done in a regional office. Well, it’s not done 

anyway when you look at a lot of the cases that are being brokered 

to other areas because they are not performing adequately. I would 

like to just, you know, see whether or not you would really consider 

looking at, you know, centers of excellence for those very complex 

cases since you can move it electronically once the VBMS system 

is up and completely running fully. 


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Mr. MURPHY. We would consider the centers of excellence concept. In fact, my staff is going through now, pulling numbers in 

terms of accuracy, rating capacity, et cetera, on regional offices 

right now to identify are there some clear outliers that say, this 

should be a COE for PTSD; this one should be for military sexual 

trauma; this one should be for TBI. So we’re going through that 

process now. We’re just beginning that process. It’s not quick. It’s 

going to take some time to do the—to make sure we get it right. 

But if there are some centers of excellence that are doing it right 

out there now, there’s some lessons for it. Number one is, should 

I make them the center for all over the country, and number two, 

if the answer is, no, I should not, then what are they doing different to get it right that I need to teach the other regional offices? 

So either way it goes, this analysis that we’re doing is going to 

yield good things for us. 

Back to the other part of your question which was the VSOs having some concern about them not being able to have that interaction and look at the file and review it. In the paper world that 

was a problem. In the electronic world with the stakeholder enterprise portal we have in place and the very shortly coming up releases which will allow them to see much more of the claim filed 

and the decision that is being made, they’ll be able to perform that 

review from anywhere in the country, regardless of what regional 

office is working that file. 

Mr. MICHAUD. I appreciate that answer because for me, I think 

our number one priority should be making sure the veteran is 

taken care of, not whether or not that claim is processed in a regional office, particularly if that regional office is not performing 

the way it should be. So thank you very much. Thank you, Mr. 

Chairman. 

Mr. RUNYAN. Thank you, gentlemen, and I actually have another 

question. I know Mr. O’Rourke is going to come back. So Mr. Murphy, your testimony highlights that VBA has improved policies and 

procedures to ensure more timely and accurate decisions to veterans of complex claims. 

Setting aside the discussion we just had about strong concerns 

on how VBA calculates accuracy, VA’s work towards better policy 

and procedure is welcome. But what the Committee is hearing from 

the IG is that a regional officer repeatedly failing to comply with 

the policies that are in place, to auditors, directors, and managers, 

this can be a theoretical exercise, but to the veteran who is underrated or denied because a regional office is not compliant, this is 

a complete failure. And as I read the American Legion’s testimony, 

for those and its quote: ‘‘For those veterans, VA’s accuracy might 

as well be zero. The Inspector General consistently reports that the 

need for policy guidance, oversight training, and supervisory review, and yet 17 of 20 recently inspected offices remain or non-comply with VBA policies, most of which were found to be repeatedly 

out of compliance.’’ 

How are you going to enforce compliance or to put it another 

way, what will be the penalty for non-compliance? 

Mr. MURPHY. I can’t answer directly your question on what will 

be the penalty for non-compliance. That falls under the Office of 

Field Operation and Deputy Under Secretary Rubens. However, I 


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can tell you what we’re doing to ensure compliance is happening. 

And the solution is not going out yelling at regional offices’ directors and telling them you must solve the process. The solution is 

for me to put a system in place which takes them down that path, 

and the right way becomes the path of least resistance. 

An example of how we’re doing that today is, number one, I 

talked about how we changed the rules around PTSD, so we no 

longer had to go away and make a determination about the 

stressor and get a buddy statement saying, what happened? We 

changed the rules so that if the veteran came in and said I was 

in fear for my life, they served in a hostile environment, you order 

an exam and you assess them for PTSD. So that’s the way we handle it from the rule side. 

When I look at it from the what system am I putting in place 

to ensure at a grassroots level, I got to take this back to the temporary 100 percent. And the example there is, in the system we’ve 

put in place with VBMS, you can no longer just hit a button and 

move through a screen. You’re forced to stop and put a routine future exam date in place and place that item under control before 

the rater is allowed to press the button and move to the next 

screen. The point is, I forced the behavior without having to go out 

and push and discuss and come back and reexamine. I know that 

it’s happening, because I can track it and I can see it on my system, and I pull a report every two weeks. And that every two-week 

report, last year I was seeing 600 cases. Now I’m seeing 50 cases. 

And the reason for that is, today there is somewhere in the 

neighborhood of 74, 75 percent of our cases are electronic through 

VBMS. We are still working through the last of the paper. So, as 

we move to the electronic environment, the compliance rate will go 

up and then I’ll see that number drop over time. 

So the answer to your question is I fix it by putting procedures 

in place that drive the RO in the right direction, and I put system 

fixes in place that force the behavior that we need to have to ensure the veteran gets the right decision. 

Mr. RUNYAN. And before I yield to Mr. O’Rourke, I would remind 

you and remind everybody how many times Secretary Shinseki has 

sat there and talked about accountability, and how are we going to 

hold people accountable. And that’s ultimately where we have to 

get to. You can do all the systematical stuff you want. If you’re not 

motivating people to do it—I know they are highly motivated people; they want to do right by the veteran. But there’s a lack of accountability there, and this is across the board. But, with that, I’ll 

yield to Mr. O’Rourke. 

Mr. *O’Rourke.* Mr. Chair, thank you. I apologize for missing 

part of the second half of the hearing, and I’ll get an update from 

those who are here about how you responded to some of the specific 

issues raised by Mr. Price and Ms. McNutt, and the veteran service 

organizations that were here. But so just briefly I’ll bring up two 

issues. One is in El Paso at Fort Bliss, we have 1,800 IDES cases; 

1,100 of those are backlogged at the DRAS site in Seattle. And so, 

just a plea from Colonel Hymel at William Beaumont from us in 

our office representing those soldiers. You know, whatever you can 

do to provide additional attention and focus on that so that we can 

get those folks through there. 


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We have some associated problems with our Wounded Warrior 

transition unit there, and part of that is having these folks who are 

in this backlog disappear in the bureaucratic loop. 

The second one, you know, Ms. Price mentioned that she filed a 

fully developed claim and took us through every part of what she 

went through to do that. You know, we’ve been pushing for fully 

developed claims filed on-line. We think that through things like 

the Faster Filing Act and other initiatives that have come out of 

this Committee, we can cut the wait time, which in El Paso right 

now for a typical veteran is 450 days out of the Waco Regional Office down to something like 100 or less. 

So I want to just pick up on what Ms. Price said and I want you 

to address the concern that that raised with me and others, that 

there may be a problem will fully developed claims, and our ability 

to process them in a timely fashion and do so accurately. 

Mr. MURPHY. Let me start with IDES. Yes, we understand exactly what you are talking about and with Fort Hood and Department of the Army—— 

Mr. *O’Rourke.* Fort Bliss. 

Mr. MURPHY. Fort Bliss. Sorry. 

Mr. *O’Rourke.* Yeah. 

Mr. MURPHY. With Fort Bliss, and we put some definitive actions 

in place—that you’ll see the numbers that are—that regional office, 

that DRAS site—start going in the right direction. First of which 

is in April, all of the employees at the Seattle D1BC—Day 1 

Brokering Center. We shut down the Day 1 Brokering Center and 

rolled it into the IDES site. What that does is it gives them immediate trained capacity to go in and start working IDES cases. 

Two, in May of 2013 we hired an additional 36 raters in that regional office. Now that sounds like, oh, they’ve been there since 

May, but the reality is they just started working last month, because they just completed challenge training and now they’re in 

production, working in the DRAS, working cases. 

In May of 2013, Army Reserve personnel were activated and deployed in Seattle to help the DRAS site in getting these IDES cases 

through quicker. Staff at the regional office has been working mandatory overtime from mid-May to November of this year, and right 

after the holidays they will resume mandatory overtime through 

2014, provided the funding is available to us. 

One other item that we’ve done with that is we had capacity in 

Providence to take some of those cases, because they were working 

faster. So 250 cases per month are being brokered to Providence in 

order to help take some of the pressure off of the DRAS site in Seattle. So I think in the coming months you’re going to see drastic 

changes in there. 

One other comment about the IDES process in general. To look 

at the IDES process and say it’s merely a simple claim is to call 

a complex—is really a complex claim is to call a complex claim a 

simple one. My point is this: these are the most complex of complex 

cases for veterans that are still serving. They take additional care. 

They take additional requirement, and they take joint cooperation 

between the VA and the Department of Defense. As a result, a 

timely claim going through the IDES process is measured at 295 


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days, not the 125 days like we see for the traditional rating window. 

The second part was about Ms. Price and the FDC, and I guess 

I’m not sure exactly what it is that you are asking me there, Congressman. 

Mr. *O’Rourke.* Well, I guess the concern was—and I apologize 

again. I’ve missed almost everything that you’ve had to say in response to the stories that we heard earlier. So you may have already answered many of the concerns raised. But one of those 

among many that were raised was that Ms. Price, I believe before 

transitioning out, had already prepared and filed a fully developed 

claim and yet she had this incredibly arduous long battle to get 

that claim adjudicated in a satisfactory way. And so it causes concern for me and others when we’re trying to direct veterans to file 

those fully developed claims on-line and we’re telling them that 

they can get those claims resolved. And in some cases, and I think 

the majority of cases, close to 100 days versus the average pass of 

450 days, a story like Ms. Price’s gives me some pause, and I just 

want to know whether that is truly exceptional, or whether there 

is more to that. And she seemed to indicate from other veterans 

that she had met with and assisted that she’s seeing similar cases 

to hers. 

And so, just wanted to get your quick feedback on that, and 

again, if you’ve already answered it or you’d like to answer it in 

more detail at a follow-up meeting, I’d be happy to meet with you 

then. But if you could just quickly talk about how exceptional a 

case like that is. 

Mr. MURPHY. I have to stay off discussing an individual veteran 

and that veteran’s circumstances. But what I can tell you is this: 

based on the time frame that Ms. Price submitted her claim, 2009, 

when we were receiving fully developed claims at less than two 

percent, to today we are receiving 27 percent of those claims. They 

are going through with our highest priority and they’re being 

tracked and monitored on a national basis at a national level. 

So my point is this: the experience that she saw is by no means 

typical of the process you are seeing today when the claims are 

going through in 115–120 days, through the fully developed claim 

process. 

Other things that have happened is in the very early stages of 

it we had a high rate of those claims that were entered into the 

fully developed claim process and for various reasons—right, 

wrong, or otherwise—were removed from that process and put 

through the normal channel. We track and monitor that routinely 

now to make sure that a fully developed claim that comes in maintains its path through the fully developed claim process. 

There are specific rules that will pull that claim out of that process. But now that we’ve put these controlled measures in place, it’s 

not being used or abused—it’s not being used to the rate it was 

when the fully developed claim program was new. 

Mr. *O’Rourke.* Okay. Thank you. My time has expired, Mr. 

Chair. I’ll yield back. Thank you. 

Mr. RUNYAN. Thank the gentleman. Any members have any further questions? No? On behalf of the Subcommittee, I thank you all 


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for your testimony. You are now excused. I thank everyone for 

being here with us today. 

Ensuring that our veterans receive timely and appropriate decisions regarding their service-connected claims is a top priority for 

both this Committee and the Department. It is unacceptable for the 

price that is—timeliness to be the accuracy of those decisions, and 

we’ll certainly be seeking more information in the near future on 

areas discussed as VA continues to march towards the Secretary’s 

2015 goals. 

I’d like to once again thank our witnesses for being here today. 

I just announce consent that Members have five Legislative days 

to revise and extend their remarks and include any extraneous material. 

Hearing no objections, so ordered. Thank the Members for their 

attendance today, and this hearing is adjourned. 

[Whereupon, at 6:16 p.m., the subcommittee was adjourned.] 


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APPENDIX 

STATEMENT BY JEFFREY C. HALL ON DISABLED AMERICAN 

VETERANS 

Chairman Runyan, Ranking Member Titus and Members of the 

Subcommittee: 

On behalf of the DAV (Disabled American Veterans) and our 1.2 

million members, all of whom are wartime wounded and injured 

veterans, thank you for asking DAV to submit testimony for the 

record on the Department of Veterans Affairs’ (VA) adjudication of 

complex disability claims and ensuring quality, accuracy, and consistency on complicated issues. As the nation’s leading veterans 

service organization (VSO) assisting veterans seeking disability 

compensation and other benefits, DAV has tremendous experience 

and expertise relating to the processing of claims as well as the 

various ways veterans may appeal adverse actions and decisions. 

Mr. Chairman, for the first time in years, some good news is 

coming out of the Veterans Benefits Administration (VBA) in regard to the backlog of veterans’ disability compensation and pension claims. Despite a partial government shutdown that disrupted 

progress for most of October 2013, VBA appears to have finally 

turned a corner for the first time in more than two decades. However, despite the laudable progress and milestones that have been 

achieved, significant work remains to be done before VBA can hope 

to completely eliminate the backlog and reform the claims processing system so that every claim is done right the first time, including the most complicated claims. 

At the beginning of 2013, there were more than 860,000 pending 

claims for disability compensation and pension. By the end of the 

year, that number had dropped by more than 20 percent, down to 

about 693,000 pending, a reduction of more than 20 percent. The 

number of claims in the backlog – greater than 125 days pending 

– dropped by more than a third, from over 611,000 in January 2013 

to less than 392,000 at present. VBA also increased the number of 

claims completed each month from an average of about 89,000 during the first four months of the year to more than 110,000 over the 

final eight months of the year; however the cause is unclear. VBA 

also reports that the average days for rating pending claims has 

dropped this year from 280 days to under 180 days, and there are 

virtually no claims remaining that have been pending for more 

than a year. 

The most important factor driving VBA’s productivity gains was 

undoubtedly the policy of mandatory overtime for claims processors 

that ran from May through November. During this six month 

stretch, VBA achieved significant boosts in the number of completed claims per month, reaching as high as129,488 in August, before dropping back down during the shutdown and after mandatory 

overtime ended before Thanksgiving. The other key factors boosting 

claims production were likely the increased focus on fully developed 

claims (FDC), which rose to more than 12 percent of VBA’s claims 

inventory, and the continued professional development of VBA’s 

newest employees hired during the past five years. Although VBA 

finished the roll out of both Veterans Benefits Management System 

(VBMS) and the new Transformation Organizational Model (TOM) 


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last year, this likely had only a marginal influence on productivity 

increases last year since there is a learning curve that both employees and management must complete before they reach their 

full productive potential with new systems. 

While the drop in the backlog was certainly good news, even 

more encouraging was the steady increase in the accuracy of claims 

produced throughout the year, as measured by the Systematic 

Technical Accuracy Review (STAR) teams. According to VBA, their 

12-month measure for rating claims accuracy rose from 85.7 percent at the beginning of the year to nearly 90 percent by the end 

of November. Although this remains far from the 98 percent accuracy goal put forward by the Secretary, it is a significant improvement. As VBA officials regularly point out, however, when using an 

issue-based standard, rather than claims-based since one claim 

may contain many separate issues, the accuracy rate is even higher, approaching 97% during the final months of 2013. 

There are several likely causes for the increased accuracy of rating claims. First, statutory and regulatory changes have eliminated 

virtually all errors related to the duty to notify veterans of their 

rights under the Veterans Claims Assistance Act (VCAA), since the 

required notice is now included on the application form itself. Inadequate VCAA notice had historically been one of the largest categories of STAR errors Second, the use of VBMS has automated 

many of the required development steps required to properly prepare a claim to be rated, such as scheduling compensation exams 

and routine future examinations, thereby reducing the number of 

these types of errors by more than 50 percent. Third, rating calculators and other automation tools have helped to prevent inaccurate ratings because the system will not accept disability evaluation levels outside certain parameters established for each diagnostic code. Finally, VBA’s new Quality Review Teams (QRTs) have 

had a positive effect on the quality and accuracy of ratings. 

All of this progress comes after four years of comprehensive 

transformation – that included implementation of new organizational and operating processes, new IT systems, and new training, 

testing and quality control regimes – all designed to reach the Secretary’s ambitious goals for 2015 of all claims within 125 days with 

98 percent claims accuracy. 

One of the cornerstones of this transformation is the TOM, which 

is based upon the segmentation of claims based on their complexity. At the beginning of the new process, VBA’s traditional 

triage function has been replaced with a new Intake Processing 

Center that puts an experienced Veterans Service Representative 

(VSR) at the front end of the process to divide claims along three 

separate ‘‘lanes:’’ ‘‘Express,’’ ‘‘Core,’’ and ‘‘Special Ops.’’ The Express 

Lane is for claims that are less difficult, such as those that are 

fully developed or those containing one or two issues, etc. The Core 

Lane is for processing claims involving three to seven contentions, 

as well as claims for individual unemployability. And the Special 

Ops Lane is for more difficult claims, such as those with eight or 

more contentions, long-standing pending claims; complex conditions, such as traumatic brain injury (TBI), post-traumatic stress 

disorder (PTSD), military sexual trauma (MST), special monthly 


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compensation (SMC), and other claims requiring extensive time 

and expertise. 

VBA estimates that about 30 percent of claims will be processed 

through the Express lane, about 60 percent through the Core lane 

and about 10 percent through the Special Ops lane. In each of 

these lanes, integrated teams comprised of VSRs, RVSRs and Decision Review Officers (DROs) work in close proximity so that they 

can better coordinate their efforts and increase production. Although there have been increases in both production and quality 

over the past year using the TOM, VBA must regularly measure, 

carefully analyze and continually improve its new operating procedures to fix problems and maximize efficiencies. We have been particularly interested to learn whether VBA might be tempted to 

more resources and personnel in the Express Lane as a tactic to 

generate greater production and artificially lower the pending 

backlog of claims. While such a redistribution of VBA resources 

would allow VBA to move a larger number of simple claims more 

quickly and thus lower the number of pending claims, it would 

force much longer delays on veterans awaiting decisions on the 

more complex claims, including those with eight or more contentions, or those suffering from PTSD. 

DAV recently surveyed a number of our National Service Offices 

to learn more about how VA Regional Offices (VARO) were distributing their personnel among the lanes and found wide variations. 

For example, at one VARO, the distribution of VSRs and Rating 

Veterans Service Representatives (RVSR) among the lanes was 31 

percent in the Express, 56 percent in the Core and 13 percent in 

the Special Ops. At a similar sized VARO, the distribution was 48 

percent in the Express, 22 percent in the Core and 30 percent in 

the Special Ops. While the needs in each particular VARO differ, 

there is clearly a disparity in the amount of personnel assigned to 

a particular lane. In some VAROs, DAV’s National Service Officers 

(NSOs) observed that the distribution appeared to be reasonable 

based on their observations of the makeup of that particular 

VARO’s workload, while others observed understaffing of one or 

more of the segmented lanes. Others commented that too often 

VARO personnel were being shifted from one lane to another based 

upon the current month’s priority. It is essential that VBA be 

aware of such wide ranging differences among VAROs, analyze 

both workload data and the distribution of resources, and ensure 

that sufficient personnel are being assigned to each of the lanes, 

particularly the more complicated claims that require greater time 

and expertise. 

According to VBA, employees working within the Special Ops 

Lane are individuals who possess the highest skill level, and are 

required to complete an additional 20 plus hours of training and 

testing on more complex issues such as TBI and MST to ensure accuracy when preparing a rating. Additionally, all ratings in the 

Special Ops Lane require a second signature until the RVSR has 

demonstrated a 90 percent accuracy with consistency. While the 

exact number of necessary personnel assigned to handle the more 

complex claims like TBI, PTSD, etc., within the Special Ops Lane, 

or their respective experience level is difficult to ascertain, DAV beVerDate Aug 31 2005 11:11 Oct 21, 2014 Jkt 000000 PO 00000 Frm 00087 Fmt 6621 Sfmt 6602 Y:\85872.TXT PAT

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lieves these individuals should be the more experienced and skilled 

employees, particularly RVSRs. 

Another concern expressed by some of DAV’s NSOs was that 

VBA was sometimes placing claims in the wrong lanes: complex 

claims going through the Core lane or too many multi-issue claims 

being directed to the Express lane. In order to prevent these errors 

in directing claims to the right lane, VBA must ensure that the 

personnel at the Intake Processing Center of each VARO have the 

proper training and experience required to make these crucial decisions. 

A related concern we have is that VBA may be neglecting the 

preparation of claims awaiting certification to the Board of Veterans’ Appeals. There have been reports that some VAROs have redirected some VSRs and RVSRs who normally work on preparing 

appeals instead to work only on claims that contribute to lowering 

the backlog. Again, such an approach may yield short-term gains 

in reducing the claims backlog, but it will have longer term negative consequences for the growing backlog of appeals, which now 

stands at more than 266,000. 

In order to continue incentivizing quality and accuracy along 

each track, especially the Special Ops lane for complicated claims, 

VBA must also ensure that performance standards are adjusted appropriately for VSRs’ and RVSRs’ work on each of the different 

tracks within the new organizational model. Production standards 

for VSRs and RVSRs handling the simplest claims must be different from those handling the most complex, which take more 

time per claim. Employees handling complex Special Ops claims 

should not be held to the same performance levels in terms of 

claims completed per day as those handling simpler Express 

claims. 

Understanding that this model will continue to change as technology evolves concurrently, it would be wise for VBA to consult 

with the American Federation of Government Employees (AFGE) 

and other labor representatives in developing a mutually acceptable framework for quickly adjusting performance standards in the 

future as conditions merit. As new processes and technologies come 

online, it is imperative that VBA be able to make timely adjustments to performance standards to ensure that production pressures do not outweigh the goals of accuracy and quality. DAV believes that VBA must develop a scientific methodology for measuring the resources (primarily personnel) required to accurately 

and timely process the current and future anticipated workload, as 

well as a new model for allocating those resources among VA regional offices. 

One of the keys to reducing the backlog has been and will continue to be the FDC program. DAV continues to actively support 

the FDC program and by the end of fiscal year 2013, nearly 25 percent of all claims submitted to VBA were filed through the FDC 

program. This approach not only lowers the burden on VBA employees, it also results in faster and more accurate claims decisions 

for veterans. However, we recognize that not all claims can be filed 

as ‘‘fully developed’’ and VBA must continue to maintain and improve the manner in which it processes complex claims. 


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Mr. Chairman, in order for VBA to complete the transformation, 

end the backlog and decide each claim right the first time, it must 

develop and inculcate a new work culture based on quality and accountability. At a time when so much national attention has been 

focused on reducing the number of claims pending in the backlog, 

VBA must continue to place at least equal emphasis on quality and 

accuracy, rather than just speed and production. In fact, accurately 

deciding a veteran’s claim for disability should never compromised 

or sacrificed for the sake of productivity. DAV has and always will 

maintain the VBA’s attention and focus should be on generating 

decisions that are right the first time. This particularly applies to 

those claims that are more complex and complicated. 

Unfortunately, most of the metrics that VBA employs today are 

based primarily on measures of production, rather than quality. 

For example, the most common way to measure the VBA’s progress 

is through its Monday Morning Workload Reports, which contain 

measures of production, but not accuracy or quality. Another major 

tool used to review VBA’s status is its ‘‘Aspire Dashboard,’’ which 

provides current performance statistics for each VARO, and provides national totals. Like the Monday Morning Reports, however, 

the Aspire Dashboard metrics are primarily related to pending 

work inventory and production times, with only a few measures of 

accuracy included. VBA must develop new and realistic metrics and 

performance measures at every level in the process: from claims 

processors to regional office management to central office leadership. 

VBA must continue to make the changes to its work culture so 

that quality and accuracy are the cornerstones of all their activities, especially in dealing with complex claims. DAV believes that 

VBA’s creation of Quality Review Teams was a powerful statement 

of VBA’s commitment to quality. QRTs perform several functions: 

they conduct local quality reviews, perform in-process reviews and 

provide select training. In particular, the in-process reviews, often 

referred to as ‘‘mulligan reviews,’’ allow errors to be corrected before they negatively affect a rating decision, and without penalizing 

the VBA employee. VBA must continually evaluate and improve its 

training, testing, and quality control programs in order to truly reform the claims system over the long term. 

Another key to changing VBA’s culture is how well they invest 

in the training, testing and professional development of its workforce. Over the past several years, VBA has reengineered its ‘‘challenge’’ training program for new employees, which consists of four 

weeks of in-station training via ‘‘live meeting’’ software, followed by 

four weeks of in-residence training at the Baltimore academy or 

other centralized locations around the country. Every employee is 

also required to complete continuing training of 85 hours per year 

coupled with required testing. In addition, VBA has developed a 

new training program called Station Enhancement Training (SET), 

which requires all employees at targeted poor performing VAROs 

to undergo comprehensive training together for one week. First 

begun at some of VBA’s lowest performing stations, including Oakland, Los Angeles and Baltimore, SET allows employees to review 

and refresh their knowledge, while also providing structured time 

to work live cases under the supervision of the training staff. VBA 


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has reported that SET training not only increased quality, it also 

boosted morale of employees and VBA expects to continue SET 

training in 2014. 

Finally, VBA’s transformation strategy depends on the successful 

implementation of new technology, including the VBMS, the Stakeholder Enterprise Portal (SEP), an expanded e-Benefits system 

with VONAPPS Direct Connect (VDC), and the Virtual Lifetime 

Electronic Record (VLER) initiative. In terms of processing claims, 

the most important technology is VBMS, the paperless, rules-based 

system that VBA uses to create electronic claims files, manage 

workflow and determine ratings. VBA was able to complete implementation of VBMS ahead of schedule in June and by the end of 

2013, nearly all of VBA’s pending claims were processed using electronic files. Going forward, VBA must continue to receive and allocate sufficient funding for scanning paper claims forms and evidence, including the back-scanning legacy files, and must monitor 

and work to improve the quality of the scanned documents. 

It is also vitally important to recognize that no modern IT system 

or software is ever truly ‘‘finished,’’ In addition to the funding required for maintenance of the VBMS system, VBA must continue 

to make significant investments in VBMS development for as long 

as this system is capable of meeting VBA’s needs. The coding and 

embedding of rating calculators inside VBMS, for example, remains 

a labor-intensive, time-consuming process and one that will continue as the VA Schedule for Rating Disabilities (VASRD) is continually updated in the future. Furthermore, as new IT technologies 

emerge, and new requirements for VBA are identified, VBMS must 

evolve to address those needs and opportunities, and that will require an aggressive development program that has sufficient resources. At the same time, VBMS must be carefully developed to 

ensure that it also provides sufficient support for complex claims 

that are not easily done through automated and rules-based processes. 

Mr. Chairman, while VBA should be commended for the progress 

made in reducing the backlog of pending claims, now is not the 

time for them or Congress to shift any resources or attention away 

from their longstanding problems in processing claims accurately 

and timely. DAV believes VBA’s new organizational model of segmented lanes is moving in the right direction but there is still work 

to be one to ensure greater consistency and efficiency throughout 

all VAROs. 

By their very nature, complex claims are more difficult to process 

from the development stage through final rating. VBA must ensure 

that they assign the most skilled and experienced individuals to 

process these claims as well as those at the front end responsible 

for assigning claims to the proper lanes. Ultimately, the success of 

VBA’s transformation will not be judged on how well they process 

the large number of simple claims, but on how accurately and 

quickly they adjudicate the most complex claims. Getting all claims 

decisions right the first time is the only fair and equitable way to 

treat to our nation’s veterans, their dependents and survivors. Anything less is unacceptable. 

Mr. Chairman, this concludes my testimony. I would be happy to 

answer any questions you or the Subcommittee. 


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PATRICIA DRISCOLL ON THE ARMED FORCES FOUNDATION 

Chairman Runyan, Ranking Member Titus, and Distinguished 

Members of the Committee, on behalf of the Armed Forces Foundation (AFF), I would like to thank you for the opportunity to share 

our views regarding the work the AFF does for recently separated 

service members suffering from the invisible wounds of war. 

The Armed Forces Foundation is a 501(c)3 non-profit dedicated 

to supporting and advocating for active-duty military personnel, 

National Guardsmen, Reservists, military families, and veterans. 

The AFF returns 95 cents of every dollar raised to service members 

and their families through our programs. Since 2001, the AFF has 

provided more than $75 million in assistance by covering travel, 

hotel rooms, home mortgages, car payments and everyday bills for 

families to be able to stay at their loved ones’ sides during treatment and recovery from wounds suffered during war. With the 

launch of our Help Save Our Troops campaign, the AFF proactively 

educates Americans about the hidden wounds of war, including 

Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI), and advocates for those troops and veterans who have 

suffered these hidden wounds. The ultimate goal of Help Save Our 

Troops is to reduce military suicides. Through this campaign, the 

AFF provides counseling services for military families, including 

children, grants for therapy and addiction counseling, and runs a 

variety of recreation group therapy programs to boost morale 

amongst service members, veterans, and their families. 

The program I would like to highlight today is the C.W. Bill and 

Beverly Young Financial Assistance Fund, the largest program administered by the AFF. The Fund provides direct financial assistance to service members, veterans, and their families facing financial hardship due to injuries and other service-related situations. 

With the ability to provide money to service members and their 

families from all branches of service, the Foundation makes a valued impact on the lives of those who serve the United States. 

Due to the increasing number of recent veterans, the Foundation 

is unable to fill all requests for assistance. Currently, the AFF is 

only able to fulfill 18 percent of all requests made. This is why our 

Board has limited the parameters of the Fund to active-duty service members, reservists, guardsmen, and service members who 

have separated from the service within the past 18 months. Additionally, the Board has established we distribute, each year, at 

least 90 percent of our funds raised. We do not sit on the cash that 

is donated. 

Since the Fund’s inception, millions have been distributed in the 

form of direct financial grants. Cases are reviewed on a monthly 

basis and payments are made directly to creditors or in the form 

of gift cards to in order for veterans to provide the basic essentials 

for their families. 

Of the cases reviewed thus far in 2013, 35 percent of grants 

awarded have gone to recently separated service members. Of these 

cases, exactly 50 percent have been diagnosed with Post-Traumatic 

Stress Disorder (PTSD), Traumatic Brain Injury (TBI), or both. 

These statistics are startling to me, given the fact the National 

Institute of Health estimates 1 in 5 veterans of OIF/OEF suffer 


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from PTSD. Even more troubling is the recent VA IG report findings that VA offices are not handling PTSD cases correctly. 

With the ever growing backlog of VA claims and the inability to 

process these complex claims correctly, our nation’s veterans are 

struggling at home to pay their bills and put food on the table. 

This is where the AFF is proud to step up and fill the gap as 

veterans’ claims are in limbo. As PTSD diagnoses increase each 

year, so to do the requests for financial grants, as more time lapses 

before a rating is assigned to veterans suffering from the invisible 

wounds of war. 

Again, the AFF would like to thank you for the opportunity to 

present our thoughts on this important issue that many veterans 

face. We look forward to working with this Committee to find a solution to the problems being pushed onto veterans. f 

STATEMENT OF THE TRAGEDY ASSISTANCE PROGRAM FOR 

SURVIVORS (TAPS) 

Hearing: ‘‘Adjudicating VA’s Most Complex Disability Claims: 

Ensuring Quality, Accuracy and Consistency on Complicated 

Issues’’ 

We are pleased to have the opportunity to submit this testimony 

on behalf of the Tragedy Assistance Program for Survivors (TAPS). 

TAPS is the national organization providing compassionate care 

for the families of America’s fallen military heroes. TAPS provides 

peer-based emotional support, grief and trauma resources, grief 

seminars and retreats for adults, Good Grief Camps for children, 

online and in-person care groups, casework assistance, connections 

to community-based care, and a 24/7 resource and information help 

line for all who have been affected by a death in the Armed Forces. 

Services are provided to families at no cost to them. We do all of 

this without financial support from the Department of Defense. 

TAPS is funded by the generosity of the American people. 

TAPS was founded in 1994 by a group of surviving families following the deaths of their loved ones in a military plane crash. 

Since then, TAPS has offered comfort and care to more than 40,000 

people. The journey through grief following a military death can be 

isolating and the long-term impact of grief is often not understood 

in our society today. On average, it takes a person experiencing a 

traumatic loss five to seven years to reach his or her ‘‘new normal.’’ 

TAPS has extensive contact with the surviving families of America’s fallen military service members, making TAPS uniquely qualified to comment on issues affecting the survivors left behind. TAPS 

received an average of 13 newly bereaved survivors per day in 

2012. Survivors are referred to TAPS through our relationships 

with the Armed Services casualty assistance officers and direct contact from those who are grieving the death of someone who died 

while serving the Armed Forces. 

In 2012, 4,807 new survivors came to TAPS for comfort and care. 

In 2013, the number of newly-bereaved military families coming to 

TAPS for care and support continues to climb. Between January 1 

and October 24, 2013, TAPS sadly welcomed 3,471 newly bereaved 

survivors for care and support. Causes of death were reported as 

follows by military families turning to TAPS for help and support: 


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Suicide or suicide suspected22.88 % (794) 

Hostile action/killed in action/Navy Yard shooting22.47 % (780) 

Accident – auto/aviation/other22.13 % (768) 

Sudden illness17.11 % (594) 

Unknown cause of death10.89 % (378) 

Homicide 2.74 % (95) 

Non-hostile/non-combat incidents 1.73 % (60) 

Friendly-fire 0.06 % (2) 

We would like to submit the following statement on adjudicating 

VA’s most complex disability claims. 

Survivor benefits are intrinsically linked to veteran disability 

claims filed with the Department of Veterans Affairs (VA). Eligibility for VA survivor benefits for the surviving spouse and/or children hinges on establishing a military service connection to the 

cause of death. When a service connection is not recognized by the 

VA, the surviving spouse and/or children will often struggle to obtain survivor benefits. 

These benefits and services provided by the VA for spouses, children and parents of service members and veterans are significant 

and can directly impact the quality of life for survivors. These benefits can include: dependency and indemnity compensation, parents’ dependency and indemnity compensation, survivors’ pension, 

the dependents’ educational assistance program, the post-9/11 G 

Bill: Marine Gunnery Sergeant John David Fry Scholarship program, and home loans. Survivors can also receive the following 

services from the VA if they are eligible: educational and vocational 

counseling, beneficiary financial counseling, civil service preference, 

commissary and exchange privileges, and fiduciary services. 

The following data is from the quarterly Monday Morning Workload Reports published online by the Veterans Benefits Administration (http://www.vba.va.gov/reports/mmwr/). 


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* Award adjustments: Involves the modification of benefits based 

upon additional ancillary factors. Such activity usually occurs when 

a Veteran or survivor is currently entitled and receiving benefits, 

such as adjudication of dependency issues. 

** Accrued benefits: Benefits not paid prior to the death of a Veteran or survivor based upon a pending claim at the time of death 

which is later granted. 

Progress has clearly been made by the VA in 2013 to reduce the 

number of survivors waiting over 125 days for benefits who are filing initial claims, pension claims, or burial benefits. These categories show some improvements, with volume lowering. 

Even with these improvements, thousands continue to wait over 

125 days (more than four months) for benefits to be processed. The 

number of survivors waiting for award adjustments (dependency), 

accrued benefits and appeals continues to climb. 

TAPS is seeing an increasing number of survivors seeking assistance with complex VA claims for survivor benefits. In these situations, military service connection to the cause of death is not established prior to the death, often because the veteran had not applied 

for VA disability compensation for him or herself prior to the 

death, and because the death was not an active duty death. 

In these situations where service connection to the death, and 

therefore eligibility for survivor benefits, is denied by the VA, the 

grieving survivor must prepare evidence and appeal to the VA in 

order to qualify for survivor benefits. Often these cases involve a 

veteran who died by suicide. Their traumatized families must compile significant dossiers including military service records, health 

records, and statements from colleagues and friends of the veteran. 

Often these appeals can take years, while the surviving spouse, 

children and parents suffer without the benefits to which they are 

entitled to under law. 

In one case, a widow of a Navy veteran who died by suicide at 

age 29 in 2011, has spent the last two years attempting to prove 

service connection to her husband’s death and been denied twice by 

the VA. At the time of the death, their dependent children were 

ages 5 and 7. Her husband was under VA care at the time of his 

death, attempted suicide while under VA care, and he did not file 

a claim for VA disability compensation while alive because he felt 

there were others who were more deserving of support. There are 

medical treatment records on file for him but he did not apply for 

service connected disability compensation prior to his death. She 

states that one of his VA caseworkers said to her that if he wanted 

to die by suicide, there was nothing that she could do to stop it. 

She believes her husband’s problems may have been linked to problems he experienced coming out of anesthesia for a hernia surgery 

at the VA. After the surgery, his wife states that his mental health 

declined and he talked about trauma he had been exposed to while 

in the military. She interred her husband in a national cemetery 

managed by the VA in Bushnell, Florida. She states that a month 

after his funeral, she received a letter from the VA saying his military personnel and service records were lost, so she had to scan his 

entire service jacket and send it to the VA in order to apply for survivor benefits. Her applications for benefits have been denied twice. 

The widow and their two young surviving children would benefit 


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greatly from the benefits that military service connection to the 

death would permit. She is currently making a decision on whether 

to appeal the VA’s decision and attempt again to prove service connection to the death. Her case illustrates many of the challenges 

survivors with complex VA claims face. 

We thank the subcommittee for accepting our statement. 

DISCLOSURE STATEMENT 

The Tragedy Assistance Program for Survivors (TAPS) has not 

received any Federal grant or contract, relevant to the subject matter of this statement, during the current or previous two fiscal 

years. f 

MS. SULIN SCHAFER 

Adjudicating VA’s Most Complex Disability Claims: Ensuring 

Quality, Accuracy and Consistency on Complicated Issues 

My name is Sulin Schafer. My husband, Errick Schafer is a veteran of the United States Air Force. He served for about 10 years 

as a fire fighter and had been on multiple deployments. We have 

been married for almost twelve years, and have two young sons. 

Errick is also young (in his thirties). He was a top performing military service member, and also participated in any sport with a ball. 

He coached my oldest son’s sport teams; bass fished, went to the 

gym, and ate healthy everyday. He was full of energy and had a 

very contagious laugh. He did everything right to maintain his 

health. 

These days, my husband spends most of his days either sitting 

on our living room couch or laying in bed. He depends on me to 

get him in and out of bed, get dressed, eat, bathe, and use the 

bathroom. My once energetic husband who was full of laughter and 

life is now confined to a body that he cannot control. If that wasn’t 

enough, he no longer has that contagious laugh and can’t hold our 

newborn son. What’s the cause of all this misery? In November 

2012, Errick was diagnosed with Amyotrophic Lateral Sclerosis 

(ALS/Lou Gehrig Disease). The doctor said it was military service 

connected. Apparently, there are military service members who 

have been deployed to the Middle East, like my husband, and have 

been diagnosed with this death sentence. 

The doctor suggested we go through the Veteran’s Administration to file a claim for the disability. When Errick first filed the 

claim, in November 2012, he was still able to walk. The VA granted 

Errick a decision of 100% for ALS. By this November, I must transport Errick in a manual wheelchair to get around the house. He 

cannot use his hands or legs. He cannot speak clearly, so he is silent for the majority of the time he is awake. We rarely leave the 

house because of the difficulty it takes to get in and out of the vehicle. For a couple of months, because I was pregnant, my husband 

had friends from the fire department coming over to help. In October, I gave birth to our son, and now have to go back to work in 

the beginning of December. 

Errick had applied for the SMC for Aide and Attendance, and 

was granted the upgrade. When we discussed the upgrade with a 

friend, he advised us that the amount did not sound right for the 


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condition my husband is in. He suggested we speak with his father 

in law who had retired from the VA as a ‘‘rater’’. Our friend’s father in law looked over the decision letter and confirmed that my 

husband was entitled to a higher rating because he has no use of 

his upper or lower extremities. He assisted us in filing a Notice of 

Disagreement and told me to submit it to the VA Representative 

near Eglin Air Force Base. 

Early November, I went to the VA near Eglin AFB to attempt 

to submit the NOD to the representative. She told me she would 

look over it for me. After a short overview of the NOD, she told me 

that it was wrong, and that my husband has the highest rating for 

SMC. Being that I am not an expert on filing claims with the VA, 

I believed her to be correct. She said she would fix the NOD and 

call me within a couple days when she was done with it. I spoke 

to our friend’s father in law, and he said he would escort me to the 

VA office the next time I went. Well, a couple days passed, and 

then a week, but I did not hear from the representative. I decided 

to just go in, and I brought our friend’s father in law. 

He explained to her the difference between pension and compensation, and that my husband, based on his current condition, is 

entitled to a much higher rating than what he is receiving. It appeared that she did not know what our friend was explaining, even 

after he showed her in text a list of ratings directly from the VA 

website. Needless to say, we left there with nothing accomplished 

and the disappointment of still being told by a VA representative 

that my husband was still not entitled to anything else. 

It saddened me to think of the many other veterans who have 

turned to her for guidance and help in filing their claims, and possibly were turned away from what they are entitled to. This encounter has delayed the process of filing my husband’s NOD. Right 

now we really need it to hire someone to care for my husband for 

the hours that I am at work. With a diagnosis like ALS, when time 

is not on our side, this is an issue that needed to be handled more 

delicately and expeditiously. I have sent the NOD with the original 

disagreement. I have lost confidence in the knowledge that the VA 

representatives should have. f 

VETERANS AND MILITARY FAMILIES FOR PROGRESS 

December 2, 2013 

Congressman Jon Runyan 

Chairman, Disabilities Assistance and Memorial Affairs SubCommittee 

334 Cannon House Office Building 

Washington, DC. 20003 

RE: Adjudicating VA’s Most Complex Disability Claims: Ensuring Quality, Accuracy and Consistency on Complicated Issues 

Mr. Chairman, 

Veterans and Military Families for Progress (VMFP) wants to 

thank you for holding this hearing on such a timely issue with regard to the Department of Veterans Affairs (VA) process of adjudication of veterans claims for disability, education and other such 

purposes for the benefits they have rightfully earned. 


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As you are well aware, the implementation of the Veterans Benefits and Management System (VBMS) has recently taken place 

within the VA system of claims centers and Regional Offices (RO’s). 

This system has yet to be properly evaluated by the legal community or by Veteran Service Organizations (VSO) responsible for representing veterans in their claims. 

It is our belief the VA’s attempt at this implementation is not in 

the best interest of the veteran. This is an electronic set of systems 

with many hidden features. It is not open to general interpretation 

or scrutiny. This adds a layer of complexity and confusion with little known results, oversight or regulatory conformance. 

In reviewing the overall process, the legal obstacles, in and of 

themselves, are a burden to most veterans and the lack of assistance from the VA initially is daunting. With this new level of unknown electronic operations, guaranteed only by VA, to process an 

initial claim is not sufficient to warrantee any level of fulfillment 

that claims are being processed accurately or consistently. In fact, 

due to recent reports on claims processing, the opposite is more 

likely true. 

Benefits claim appeals to the Court of Appeals for Veterans 

Claims (CAVC) have increased at a rate of nearly 1,000 claims per 

week. The current claims in the CAVC are at their highest point 

ever. 

In reviewing what is supposed to be the process for a veteran or 

their dependant to apply for a claim, the initial application should 

consist of the request(s) for a specific benefit (disability, education, 

medical needs, etc.) accompanied with the veteran’s Department of 

Defense form DD–214, and any supporting documentation. The increased level in obstacles to obtaining the contractually obligated 

benefits has become steeped in laws and unnecessary bureaucracy 

to the detriment of veterans and their families. 

In reviewing the level of consistency in the decisions from VA on 

claims from veterans, the comparable evidence is truly a mystery. 

Claims approvals and denials vary from state to state, region to region and office to office. In many case a veteran with a valid claim 

in a specific office will have his or her claim denied while a veteran 

with the exact same claim with the exact same evidence will submit the claim to the same office and have their claim approved. 

There is also no supporting evidence, since the implementation 

of the VBMS system, the claims process or accuracy has either 

changed or improved. Claims in this system can be determined to 

be accurate and acceptable to VA, only to have the claim denied by 

either a Regional Office (RO) or a Director of the RO. This can happen in any office anywhere within all of the offices of the VA making these determinations. Since the VBMS system can be interfered 

with or altered by an individual, the use of this technology is ineffective by most measurable standards of fairness or justice. 

In conclusion, the VA is not making any visible or measurable 

strides to create a ‘‘less complicated’’ system or improving their 

methods to help veterans. There is no measurable evidence the recent changes in VA have done anything more than add layers to 

the existing many layers of bureaucratic schemes designed to insure injustice to veterans seeking the benefits assigned to them in 

their agreement when they entered military service. The assertion 


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by the VA for the added by a technology, originally reported to 

‘‘make things easier’’ for the veterans and government, has no basis 

in fact. The issue of complexity of claims resolution is increased to 

a new level wherein there is no possible method of discovering the 

processes used to reach a decision on how VA arrived at their assessment of a claim or what was the application of law used in 

making their determination for a claim. 

VMFP respectfully requests your committee examine the disability claims process and the quality of the VA decision more 

closely in the future. Since there is no evidence to substantiate that 

claims quality, process, accuracy or complexity has improved in recent months or years, the question(s) you have asked in this hearing are of great importance to our veterans and their families everywhere. 

Respectfully, 

Ronald D. Scott 

Ronald D. Scott 

President, Veterans and Military Families for Progress 

CC: Committee List 

Æ 


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